Provider Demographics
NPI:1447951504
Name:ANGULO, ENMANUEL JUNIOR
Entity type:Individual
Prefix:
First Name:ENMANUEL
Middle Name:JUNIOR
Last Name:ANGULO
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 1:12370 SW 212TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5901
Mailing Address - Country:US
Mailing Address - Phone:305-440-8831
Mailing Address - Fax:
Practice Address - Street 1:12370 SW 212TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5901
Practice Address - Country:US
Practice Address - Phone:305-440-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-257117106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician