Provider Demographics
NPI:1619711751
Name:MOURAD, VIRGINIA C
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:MOURAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 SW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7005
Mailing Address - Country:US
Mailing Address - Phone:305-301-1632
Mailing Address - Fax:
Practice Address - Street 1:7326 SW 25TH CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7005
Practice Address - Country:US
Practice Address - Phone:305-301-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-337548106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician