MEDICARE: BETHYNEL M VEGA

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	143850	FL

General Provider Information

NPI Number	:	1811581358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHYNEL M VEGA

Provider Business Mailing Address
First Line	:	12545 NW 15TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2311
Country	:	US
Telephone Number	:	305-742-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	12545 NW 15TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2311
Country	:	US
Telephone Number	:	305-742-5456
Fax Number	:

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

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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Directions to “ BETHYNEL M VEGA ” Practice Location

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