Provider Demographics
NPI:1588259444
Name:VALCARCEL AVILA, LIUBA
Entity type:Individual
Prefix:
First Name:LIUBA
Middle Name:
Last Name:VALCARCEL AVILA
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 1:10855 SW 112TH AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3296
Mailing Address - Country:US
Mailing Address - Phone:305-213-9638
Mailing Address - Fax:
Practice Address - Street 1:10855 SW 112TH AVE APT 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3296
Practice Address - Country:US
Practice Address - Phone:305-213-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-142402106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-142402OtherBACB