Provider Demographics
NPI:1518676642
Name:VIANA, JOSE D
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:D
Last Name:VIANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:D
Other - Last Name:VIANA TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6425 WINDMILL GATE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5901
Mailing Address - Country:US
Mailing Address - Phone:678-462-2366
Mailing Address - Fax:
Practice Address - Street 1:6425 WINDMILL GATE RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5901
Practice Address - Country:US
Practice Address - Phone:678-462-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-211139106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician