Provider Demographics
NPI:1831812932
Name:ANGELES DE ESPERANZA CORP
Entity type:Organization
Organization Name:ANGELES DE ESPERANZA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEROS
Authorized Official - Suffix:I
Authorized Official - Credentials:RBT
Authorized Official - Phone:786-474-0226
Mailing Address - Street 1:12430 SW 188TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3142
Mailing Address - Country:US
Mailing Address - Phone:786-474-0226
Mailing Address - Fax:
Practice Address - Street 1:14050 SW 84TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4440
Practice Address - Country:US
Practice Address - Phone:786-474-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty