Provider Demographics
NPI:1427554187
Name:VICTORERO, LUZMILA
Entity Type:Individual
Prefix:MISS
First Name:LUZMILA
Middle Name:
Last Name:VICTORERO
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 1:43 SW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2457
Mailing Address - Country:US
Mailing Address - Phone:786-406-4933
Mailing Address - Fax:
Practice Address - Street 1:43 SW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2457
Practice Address - Country:US
Practice Address - Phone:786-406-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician