Provider Demographics
NPI:1740781582
Name:CAICEDO, LUZ ANGELA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ANGELA
Last Name:CAICEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10852 N KENDALL DR APT 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1256
Mailing Address - Country:US
Mailing Address - Phone:786-715-8236
Mailing Address - Fax:
Practice Address - Street 1:7530 SUNSET DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4132
Practice Address - Country:US
Practice Address - Phone:305-271-8790
Practice Address - Fax:305-271-8789
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician