Provider Demographics
NPI:1093585606
Name:JOVA VIDAL, SARAI
Entity Type:Individual
Prefix:
First Name:SARAI
Middle Name:
Last Name:JOVA VIDAL
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 1:7405 PALMERA POINTE CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2927
Mailing Address - Country:US
Mailing Address - Phone:813-369-2972
Mailing Address - Fax:
Practice Address - Street 1:7405 PALMERA POINTE CIR UNIT 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2927
Practice Address - Country:US
Practice Address - Phone:813-369-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-319260106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician