Provider Demographics
NPI:1700604691
Name:MAKHMUDOVA, VENERA
Entity type:Individual
Prefix:MRS
First Name:VENERA
Middle Name:
Last Name:MAKHMUDOVA
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 1:17880 NE 31ST CT APT 2209
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5008
Mailing Address - Country:US
Mailing Address - Phone:305-902-7574
Mailing Address - Fax:
Practice Address - Street 1:17880 NE 31ST CT APT 2209
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-5008
Practice Address - Country:US
Practice Address - Phone:305-902-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-377870106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician