Provider Demographics
NPI:1235654666
Name:PRIETO, VIVIANA CARIDAD
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:CARIDAD
Last Name:PRIETO
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 1:2125 W 52ND ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7095
Mailing Address - Country:US
Mailing Address - Phone:305-321-0903
Mailing Address - Fax:
Practice Address - Street 1:2125 W 52ND ST APT 203
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7095
Practice Address - Country:US
Practice Address - Phone:305-321-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022-79-6200Medicaid
FLRBT-18-58448OtherBACB-BEHAVIOR ANALYST CERTIFICATION BOARD