Provider Demographics
NPI:1669592150
Name:BLOISE, MIGUELINA (MS)
Entity type:Individual
Prefix:MRS
First Name:MIGUELINA
Middle Name:
Last Name:BLOISE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2308
Mailing Address - Country:US
Mailing Address - Phone:305-621-7492
Mailing Address - Fax:
Practice Address - Street 1:1469 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5557
Practice Address - Country:US
Practice Address - Phone:305-635-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMHC 1674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1674OtherMENTAL HEALTH COUNSELOR
FLF16819OtherCCFC
FLF17810OtherCCDVC