Provider Demographics
NPI:1174413751
Name:VICIEDO, ALEXIS MAUI
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MAUI
Last Name:VICIEDO
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 1:12930 SW 72ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3405
Mailing Address - Country:US
Mailing Address - Phone:786-395-5043
Mailing Address - Fax:
Practice Address - Street 1:9010 CORBIN AVE STE 4B
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3344
Practice Address - Country:US
Practice Address - Phone:818-770-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health