Individual
MAME-DIARRA BOUSSO FALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2828 BOGOTA AVE, HOLLYWOOD, FL 33026-4512
(786) 553-8012
Mailing address
2828 BOGOTA AVE, HOLLYWOOD, FL 33026-4512
(786) 553-8012
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
FL
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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