Provider Demographics
NPI:1558124008
Name:POZO BERRUETA, FLAVIA S
Entity Type:Individual
Prefix:
First Name:FLAVIA
Middle Name:S
Last Name:POZO BERRUETA
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 1:13603 BAYVIEW ISLE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5107
Mailing Address - Country:US
Mailing Address - Phone:407-866-8216
Mailing Address - Fax:
Practice Address - Street 1:13603 BAYVIEW ISLE DR APT 208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5107
Practice Address - Country:US
Practice Address - Phone:407-866-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician