Healthcare Provider Details

I. General information

NPI: 1518686963
Provider Name (Legal Business Name): VICTORIA ABA THERAPHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KILLIAN DR STE 107A
LAKE PARK FL
33403-1960
US

IV. Provider business mailing address

1408 N KILLIAN DR STE 107A
LAKE PARK FL
33403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 786-447-4586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LEONAIDIS CARRASCO PEREZ
Title or Position: OWNER
Credential:
Phone: 786-447-4586