Organization
ILLUMINATING LIVES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSARIO VALLADARES (PRESIDENT)
(786) 200-2208
Entity
Organization
Contact information
Practice address
11510 SW 80TH ST, MIAMI, FL 33173-3603
(786) 282-9935
Mailing address
11510 SW 80TH ST, MIAMI, FL 33173-3603
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/14/2011
Last updated
07/10/2014
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