Provider Demographics
NPI:1447850680
Name:VILTRES, ALEXIS RENE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RENE
Last Name:VILTRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 NW 107TH CT UNIT 106
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2139
Mailing Address - Country:US
Mailing Address - Phone:786-674-6078
Mailing Address - Fax:
Practice Address - Street 1:9745 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6932
Practice Address - Country:US
Practice Address - Phone:786-701-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB583801106S00000X
FLRBT-20-124070106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty