Provider Demographics
NPI:1437836202
Name:ARTETA VALECILLOS, KITTYS COROMOTO
Entity Type:Individual
Prefix:
First Name:KITTYS
Middle Name:COROMOTO
Last Name:ARTETA VALECILLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KITTYS
Other - Middle Name:COROMOTO
Other - Last Name:ARTETA VALECILLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KITTYS ARTETA
Mailing Address - Street 1:6249 RED CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8310
Mailing Address - Country:US
Mailing Address - Phone:786-461-6493
Mailing Address - Fax:
Practice Address - Street 1:6249 RED CEDAR CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-8310
Practice Address - Country:US
Practice Address - Phone:786-461-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst