Provider Demographics
NPI:1508670589
Name:OVIEDO MUR, MELIZA BARBARA
Entity type:Individual
Prefix:
First Name:MELIZA
Middle Name:BARBARA
Last Name:OVIEDO MUR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 RIVER DR APT C103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-7034
Mailing Address - Country:US
Mailing Address - Phone:813-410-1734
Mailing Address - Fax:
Practice Address - Street 1:550 SE PORT ST LUCIE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5108
Practice Address - Country:US
Practice Address - Phone:772-202-0173
Practice Address - Fax:772-209-7631
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-407659106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician