=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306550876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABALUZ CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2023
-----------------------------------------------------
Last Update Date | 01/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13937 SW 173RD TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33177-7711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-406-4933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13937 SW 173RD TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33177-7711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-406-4933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LUZMILA VICTORERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-406-4933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------