Provider Demographics
NPI:1942751508
Name:FLORIDA COMMUNICATION CENTER, LLC
Entity Type:Organization
Organization Name:FLORIDA COMMUNICATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:305-458-0491
Mailing Address - Street 1:2915 SW 102ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2867
Mailing Address - Country:US
Mailing Address - Phone:305-458-0491
Mailing Address - Fax:
Practice Address - Street 1:9280 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1507
Practice Address - Country:US
Practice Address - Phone:305-458-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty