Provider Demographics
NPI:1417475534
Name:MORALES OBANDO, VIRGINIA NATALIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:NATALIA
Last Name:MORALES OBANDO
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 1:228 SW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1708
Mailing Address - Country:US
Mailing Address - Phone:305-200-6991
Mailing Address - Fax:
Practice Address - Street 1:228 SW 20TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1708
Practice Address - Country:US
Practice Address - Phone:305-200-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-21-52043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst