Provider Demographics
NPI:1881293033
Name:SAN JUAN ARIAS, NORAYMA SR
Entity type:Individual
Prefix:MRS
First Name:NORAYMA
Middle Name:
Last Name:SAN JUAN ARIAS
Suffix:SR
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 1:10362 SW 212TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3074
Mailing Address - Country:US
Mailing Address - Phone:786-231-9978
Mailing Address - Fax:
Practice Address - Street 1:4800 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6426
Practice Address - Country:US
Practice Address - Phone:305-515-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180552106S00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker