Healthcare Provider Details

I. General information

NPI: 1760716930
Provider Name (Legal Business Name): MARIA VICTORIA CIOCCA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 SW 138TH ST
PALMETTO BAY FL
33158-1251
US

IV. Provider business mailing address

7650 SW 138TH ST
PALMETTO BAY FL
33158-1251
US

V. Phone/Fax

Practice location:
  • Phone: 305-219-2087
  • Fax:
Mailing address:
  • Phone: 305-219-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 9319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: