Provider Demographics
NPI:1033895701
Name:ALEXIS-DOCTEUR, NIRVA
Entity Type:Individual
Prefix:
First Name:NIRVA
Middle Name:
Last Name:ALEXIS-DOCTEUR
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 1:15664 NE 10TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5346
Mailing Address - Country:US
Mailing Address - Phone:305-801-2685
Mailing Address - Fax:
Practice Address - Street 1:15664 NE 10TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5346
Practice Address - Country:US
Practice Address - Phone:305-801-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23279765106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician