Provider Demographics
NPI:1841773546
Name:IGLESIAS, ENMANUEL ALEJANDRO
Entity Type:Individual
Prefix:MR
First Name:ENMANUEL
Middle Name:ALEJANDRO
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 NW 27TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3000
Mailing Address - Country:US
Mailing Address - Phone:786-431-1133
Mailing Address - Fax:786-431-1133
Practice Address - Street 1:THERA-PRO CARE ,LLC 888 NW 27 AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:786-431-1133
Practice Address - Fax:786-431-1287
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ8805Medicaid