Provider Demographics
NPI:1891527354
Name:PIZARRO ACOSTA, PAOLA ANGELY
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANGELY
Last Name:PIZARRO ACOSTA
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 1:19900 NW 37TH AVE LOT A15
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1706
Mailing Address - Country:US
Mailing Address - Phone:787-529-1449
Mailing Address - Fax:
Practice Address - Street 1:19900 NW 37TH AVE LOT A15
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1706
Practice Address - Country:US
Practice Address - Phone:787-529-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24--354417106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician