Provider Demographics
NPI:1134739568
Name:PONS MESA, VITIANA (RBT)
Entity type:Individual
Prefix:
First Name:VITIANA
Middle Name:
Last Name:PONS MESA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9282 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4122
Mailing Address - Country:US
Mailing Address - Phone:786-622-3375
Mailing Address - Fax:
Practice Address - Street 1:9282 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4122
Practice Address - Country:US
Practice Address - Phone:786-622-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician