Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | FL |
NPI | 1063929396 |
---|---|
Provider Name | Daniel Alejandro Victoria |
First Address | Miami, FL 33183-3805 |
Second Address | Sunrise, FL 33325-6244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
697578 | (05) | FL |