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General NPI Number Information
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NPI Number | 1972126944
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Entity Type | Organization
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Legal Business Name | VICTORIA'S RESIDENCE LLC
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 05/25/2020
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Provider Practice Location Address
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Address Line | 16413 SW 81ST TER
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City | MIAMI
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State | FL
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Zip | 33193-5717
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Country | US
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Telephone | 786-803-9318
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Fax |
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Provider Business Mailing Address
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Address Line | 16413 SW 81ST TER
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City | MIAMI
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State | FL
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Zip | 33193-5717
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Country | US
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Telephone | 786-803-9318
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMIN.
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Name | GEORGINA A. PONCE AGUILERA
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Credential |
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Telephone | 786-803-9318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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