Provider Demographics
NPI:1427340330
Name:RACHAEL IZQUIERDO, P.A.
Entity type:Organization
Organization Name:RACHAEL IZQUIERDO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:305-298-7300
Mailing Address - Street 1:9761 SW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4901
Mailing Address - Country:US
Mailing Address - Phone:305-298-7300
Mailing Address - Fax:786-293-8870
Practice Address - Street 1:9485 SUNSET DR STE A202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3228
Practice Address - Country:US
Practice Address - Phone:305-298-7300
Practice Address - Fax:786-293-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty