Provider Demographics
NPI:1558929158
Name:CANAMERO SAN MARTIN, VICTORIA MARGARITA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARGARITA
Last Name:CANAMERO SAN MARTIN
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 1:6140 SW 129TH PL APT 2007
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5251
Mailing Address - Country:US
Mailing Address - Phone:786-671-9792
Mailing Address - Fax:
Practice Address - Street 1:6140 SW 129TH PL APT 2007
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5251
Practice Address - Country:US
Practice Address - Phone:786-671-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-59470106S00000X, 106S00000X
FL0-21-11765106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician