Basic Information
Provider Information
NPI: 1083959647
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HATTON-NEGRON
FirstName: PAOLA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MS ED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11329 SW 240TH ST
Address2:  
City: HOMESTEAD
State: FL
PostalCode: 330323125
CountryCode: US
TelephoneNumber: 7864481482
FaxNumber:  
Practice Location
Address1: 11440 N KENDALL DR STE 109
Address2:  
City: MIAMI
State: FL
PostalCode: 331761024
CountryCode: US
TelephoneNumber: 3059298705
FaxNumber: 3056003714
Other Information
ProviderEnumerationDate: 12/06/2012
LastUpdateDate: 11/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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