Provider Demographics
NPI:1508541152
Name:SIERRA, VICTORIA LIZETH
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LIZETH
Last Name:SIERRA
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 1:1721 NW 15TH VIS APT 6
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1533
Mailing Address - Country:US
Mailing Address - Phone:754-204-0577
Mailing Address - Fax:
Practice Address - Street 1:1721 NW 15TH VIS APT 6
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1533
Practice Address - Country:US
Practice Address - Phone:754-204-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-262079106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty