Provider Demographics
NPI:1295232676
Name:SIVERIO CAMPOS, LUZ VIRGINIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:VIRGINIA
Last Name:SIVERIO CAMPOS
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 1:3010 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1104
Mailing Address - Country:US
Mailing Address - Phone:786-326-8277
Mailing Address - Fax:
Practice Address - Street 1:3010 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1104
Practice Address - Country:US
Practice Address - Phone:786-326-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician