Provider Demographics
NPI:1720576507
Name:COMBE, MONICA MILAGROS
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MILAGROS
Last Name:COMBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SW 161ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3673
Mailing Address - Country:US
Mailing Address - Phone:305-310-1725
Mailing Address - Fax:
Practice Address - Street 1:419 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3654
Practice Address - Country:US
Practice Address - Phone:305-822-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017422400Medicaid
FL07422400Medicaid