Provider Demographics
NPI:1548829401
Name:ILLA-EL DIK, NAJIBE N
Entity type:Individual
Prefix:MRS
First Name:NAJIBE
Middle Name:N
Last Name:ILLA-EL DIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAJIBE
Other - Middle Name:R
Other - Last Name:EL DIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 N 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7407
Mailing Address - Country:US
Mailing Address - Phone:305-220-8855
Mailing Address - Fax:
Practice Address - Street 1:630 N 70TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7407
Practice Address - Country:US
Practice Address - Phone:305-220-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X, 372600000X, 385H00000X, 385HR2065X, 253Z00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No374U00000XNursing Service Related ProvidersHome Health Aide