Provider Demographics
NPI:1679387120
Name:SILVA ESTEFANIA, ALEXIS DAVID
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DAVID
Last Name:SILVA ESTEFANIA
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 1:25280 SW 119TH AVE # 51
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4326
Mailing Address - Country:US
Mailing Address - Phone:786-660-4918
Mailing Address - Fax:
Practice Address - Street 1:25280 SW 119TH AVE # 51
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4326
Practice Address - Country:US
Practice Address - Phone:786-660-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1039542106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician