Provider Demographics
NPI:1710524301
Name:MORERA, VICTORIA DE LAS MERCEDES
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DE LAS MERCEDES
Last Name:MORERA
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 1:2344 W 66TH PL APT 8
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3900
Mailing Address - Country:US
Mailing Address - Phone:786-613-3828
Mailing Address - Fax:
Practice Address - Street 1:2344 W 66TH PL APT 8
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3900
Practice Address - Country:US
Practice Address - Phone:786-613-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide