Provider Demographics
NPI:1164035614
Name:ARTILES, VENUS LIZ
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:LIZ
Last Name:ARTILES
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 1:1910 SW 68TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2728
Mailing Address - Country:US
Mailing Address - Phone:786-818-0022
Mailing Address - Fax:
Practice Address - Street 1:5931 NW 173RD DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5106
Practice Address - Country:US
Practice Address - Phone:305-826-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-131621OtherBACB ID