Provider Demographics
NPI:1760262489
Name:OLAZABAL, AIMARA
Entity Type:Individual
Prefix:
First Name:AIMARA
Middle Name:
Last Name:OLAZABAL
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 1:2300 SPRINGDALE BLVD APT 1-117
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6382
Mailing Address - Country:US
Mailing Address - Phone:561-633-0201
Mailing Address - Fax:
Practice Address - Street 1:2300 SPRINGDALE BLVD APT 1-117
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-6382
Practice Address - Country:US
Practice Address - Phone:561-633-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-298890106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician