Provider Demographics
NPI:1447885686
Name:AGUILERA, DAYRON
Entity type:Individual
Prefix:
First Name:DAYRON
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14896 SW 25TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5636
Mailing Address - Country:US
Mailing Address - Phone:305-793-4589
Mailing Address - Fax:
Practice Address - Street 1:14896 SW 25TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5636
Practice Address - Country:US
Practice Address - Phone:305-793-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105635409Medicaid