Provider Demographics
NPI:1134771306
Name:MACHADO LEGRA, NALVIS
Entity type:Individual
Prefix:
First Name:NALVIS
Middle Name:
Last Name:MACHADO LEGRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 NW 179TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5449
Mailing Address - Country:US
Mailing Address - Phone:786-620-3013
Mailing Address - Fax:
Practice Address - Street 1:7090 NW 179TH ST APT 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5449
Practice Address - Country:US
Practice Address - Phone:786-620-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-13375106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst