Provider Demographics
NPI:1215520267
Name:APARICIO, ELYVON
Entity type:Individual
Prefix:MRS
First Name:ELYVON
Middle Name:
Last Name:APARICIO
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 1:12001 SW 128TH CT STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4666
Mailing Address - Country:US
Mailing Address - Phone:305-318-9417
Mailing Address - Fax:305-468-6454
Practice Address - Street 1:11510 SW 147TH AVE UNIT 21-23
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2443
Practice Address - Country:US
Practice Address - Phone:305-318-9417
Practice Address - Fax:305-468-6454
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2329824332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2329824OtherCATERING LICENSE