Provider Demographics
NPI:1306497086
Name:DIMAS AGUDELO, LAURA CATALINA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CATALINA
Last Name:DIMAS AGUDELO
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 1:24927 HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6307
Mailing Address - Country:US
Mailing Address - Phone:813-215-9286
Mailing Address - Fax:
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9712
Practice Address - Country:US
Practice Address - Phone:863-602-0698
Practice Address - Fax:813-354-2715
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst