Provider Demographics
NPI:1437676806
Name:MORA VEIGA, REGLA SUSANA
Entity Type:Individual
Prefix:
First Name:REGLA
Middle Name:SUSANA
Last Name:MORA VEIGA
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 1:1421 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2526
Mailing Address - Country:US
Mailing Address - Phone:305-305-2091
Mailing Address - Fax:
Practice Address - Street 1:1421 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2526
Practice Address - Country:US
Practice Address - Phone:305-305-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician