Provider Demographics
NPI:1578044848
Name:HENARES, VICTORIA MARIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIA
Last Name:HENARES
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 1:1006 FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2135
Mailing Address - Country:US
Mailing Address - Phone:305-989-3379
Mailing Address - Fax:
Practice Address - Street 1:2051 NW 112TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1835
Practice Address - Country:US
Practice Address - Phone:305-878-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist