Provider Demographics
NPI:1194437822
Name:INDIGO ABA LLC
Entity type:Organization
Organization Name:INDIGO ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-366-7352
Mailing Address - Street 1:9020 SW 137TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1427
Mailing Address - Country:US
Mailing Address - Phone:786-312-0183
Mailing Address - Fax:
Practice Address - Street 1:9020 SW 137TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1427
Practice Address - Country:US
Practice Address - Phone:786-312-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty