Provider Demographics
NPI:1932724333
Name:VICTORI, MARITZA ODALYS
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:ODALYS
Last Name:VICTORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:ODALYS
Other - Last Name:GARCIA-ONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 SW 105TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7937
Mailing Address - Country:US
Mailing Address - Phone:305-305-9049
Mailing Address - Fax:
Practice Address - Street 1:2021 SW 105TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7937
Practice Address - Country:US
Practice Address - Phone:305-305-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst