MEDICARE: DONNA VIEITEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1972360279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA VIEITEZ

Provider Business Mailing Address
First Line	:	23 RYBAR LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-6445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 ROXANNE PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-8923
Country	:	US
Telephone Number	:	386-986-6723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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Directions to “ DONNA VIEITEZ ” Practice Location

Language	Start Address	Practice Location

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