Basic Information
| Provider Information | |||||||||
| NPI: | 1003143694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUASVIVAS | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 WILES RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330672063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543411022 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7501 WILES RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330672063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543411022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH10008 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.