Provider Demographics
NPI:1508640541
Name:CAPOTE VERDECIA, ISORUMA DE LA C
Entity Type:Individual
Prefix:
First Name:ISORUMA
Middle Name:DE LA C
Last Name:CAPOTE VERDECIA
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 1:18670 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5244
Mailing Address - Country:US
Mailing Address - Phone:305-873-9557
Mailing Address - Fax:
Practice Address - Street 1:18670 NW 78TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5244
Practice Address - Country:US
Practice Address - Phone:305-873-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-276820106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician