Provider Demographics
NPI:1336846831
Name:VICTORIA SERPA, CANDIDO ALDO
Entity Type:Individual
Prefix:MR
First Name:CANDIDO
Middle Name:ALDO
Last Name:VICTORIA SERPA
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 1:11045 SW 139TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3248
Mailing Address - Country:US
Mailing Address - Phone:305-370-2422
Mailing Address - Fax:
Practice Address - Street 1:12442 SW 115TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4944
Practice Address - Country:US
Practice Address - Phone:305-370-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician