Healthcare Provider Details

I. General information

NPI: 1578863056
Provider Name (Legal Business Name): YUSIMIR VITON-MARTINEZ SLP A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MIRACLE MILE STE 403
CORAL GABLES FL
33134-4926
US

IV. Provider business mailing address

401 MIRACLE MILE STE 403
CORAL GABLES FL
33134-4926
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-1098
  • Fax: 305-446-1638
Mailing address:
  • Phone: 305-446-1098
  • Fax: 305-446-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License NumberSI1503
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: