| Angel Blue Therapy Services, Llc | |
|
721 Nw 21st Ct Miami FL 33125-3434 | |
| (786) 710-1976 | |
| Not Available |
| Full Name | Angel Blue Therapy Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 721 Nw 21st Ct, Miami, Florida |
| Authorized Official Name and Position | Noel Ferrer Rodriguez (OWNER) |
| Authorized Official Contact | 3055480456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Blue Therapy Services, Llc 721 Nw 21st Ct Miami FL 33125-3434 Ph: (786) 710-1976 | Angel Blue Therapy Services, Llc 721 Nw 21st Ct Miami FL 33125-3434 Ph: (786) 710-1976 |
| NPI Number | 1013527118 |
|---|---|
| Provider Enumeration Date | 08/04/2020 |
| Last Update Date | 01/14/2025 |
| Medicare PECOS PAC ID | 9638584329 |
|---|---|
| Medicare Enrollment ID | O20210210000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013527118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Hernan Pabon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669683751 PECOS PAC ID: 2668556507 Enrollment ID: I20080301000013 |
| Provider Name | Angela Maria Hansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235685181 PECOS PAC ID: 6002212255 Enrollment ID: I20210914000281 |
| Provider Name | Deborah Virgen Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407359946 PECOS PAC ID: 5991185506 Enrollment ID: I20220629000374 |
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