Provider Demographics
NPI:1801176409
Name:CARRERA ALVAREZ, AGUEDA LUCIA (LMT63211)
Entity type:Individual
Prefix:
First Name:AGUEDA
Middle Name:LUCIA
Last Name:CARRERA ALVAREZ
Suffix:
Gender:F
Credentials:LMT63211
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SW 29TH AVE
Mailing Address - Street 2:APT. #6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4583
Mailing Address - Country:US
Mailing Address - Phone:786-312-6847
Mailing Address - Fax:
Practice Address - Street 1:2757 SW 10TH ST APT 9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4648
Practice Address - Country:US
Practice Address - Phone:786-312-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120430106S00000X
FLMA63211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist