Provider Demographics
NPI:1013307974
Name:DAHLIA WIGGAN
Entity Type:Organization
Organization Name:DAHLIA WIGGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CONSULTANT
Authorized Official - Phone:786-470-4622
Mailing Address - Street 1:662 NE 204TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2436
Mailing Address - Country:US
Mailing Address - Phone:305-725-8836
Mailing Address - Fax:
Practice Address - Street 1:662 NE 204TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2436
Practice Address - Country:US
Practice Address - Phone:305-725-8836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization