Provider Demographics
NPI:1790167765
Name:AFRODITE FIORAVANTES
Entity Type:Organization
Organization Name:AFRODITE FIORAVANTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFRODITE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORAVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-948-8901
Mailing Address - Street 1:6412 CATHY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3642
Mailing Address - Country:US
Mailing Address - Phone:505-948-8901
Mailing Address - Fax:
Practice Address - Street 1:6412 CATHY AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3642
Practice Address - Country:US
Practice Address - Phone:505-948-8901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2374251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services