Provider Demographics
NPI:1760248231
Name:ARTILES VENTURA, DEYVIS
Entity Type:Individual
Prefix:
First Name:DEYVIS
Middle Name:
Last Name:ARTILES VENTURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 W FLAGLER ST APT C3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3012
Mailing Address - Country:US
Mailing Address - Phone:786-483-5081
Mailing Address - Fax:
Practice Address - Street 1:1806 N FLAMINGO RD STE 305
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1033
Practice Address - Country:US
Practice Address - Phone:954-478-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-322408106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician