Provider Demographics
NPI:1982412797
Name:FELIPE, MILDREY
Entity type:Individual
Prefix:
First Name:MILDREY
Middle Name:
Last Name:FELIPE
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 1:14820 SW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2777
Mailing Address - Country:US
Mailing Address - Phone:305-879-4213
Mailing Address - Fax:
Practice Address - Street 1:14820 SW 63RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2777
Practice Address - Country:US
Practice Address - Phone:305-879-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician