Organization
SOCIAL DIVERSITY LLC
Active
Other names
Suniss Up, Social Diversity LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ESEL AGUILAR FMD/CBHCMS (OWNER/CEO)
(786) 975-7485
Entity
Organization
Contact information
Practice address
12001 SW 128TH CT STE 101, MIAMI, FL 33186-4665
(786) 975-7485
Mailing address
382 NE 19TH AVE, HOMESTEAD, FL 33033-5265
(786) 975-7485
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CBHCMS100118
FLORIDA CERTIFICATION BOARD
FL
Enumeration date
02/16/2020
Last updated
05/17/2022
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