Provider Demographics
NPI:1912529843
Name:AREVALO CARRAZANA, DALIA ESTHER
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:ESTHER
Last Name:AREVALO CARRAZANA
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 1:3777 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6231
Mailing Address - Country:US
Mailing Address - Phone:305-767-0346
Mailing Address - Fax:
Practice Address - Street 1:3777 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6231
Practice Address - Country:US
Practice Address - Phone:305-767-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician