Provider Demographics
NPI:1780416883
Name:AVILE LOVERA, KAREN PATRICIA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:PATRICIA
Last Name:AVILE LOVERA
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 1:4990 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-5431
Mailing Address - Country:US
Mailing Address - Phone:305-903-5867
Mailing Address - Fax:
Practice Address - Street 1:6191 ORANGE DR STE 4472
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3457
Practice Address - Country:US
Practice Address - Phone:305-903-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24369992106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty