Provider Demographics
NPI:1356850036
Name:IGLESIAS PUIG, ANNIA
Entity type:Individual
Prefix:
First Name:ANNIA
Middle Name:
Last Name:IGLESIAS PUIG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 SW 36TH CT # 25
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5369
Mailing Address - Country:US
Mailing Address - Phone:305-772-0004
Mailing Address - Fax:
Practice Address - Street 1:6151 SW 36TH CT # 25
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5369
Practice Address - Country:US
Practice Address - Phone:305-772-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103824100Medicaid