Healthcare Provider Details

I. General information

NPI: 1336683853
Provider Name (Legal Business Name): DAMARYS MACHADO VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 ANTIQUERA AVE APT 204
CORAL GABLES FL
33134-2922
US

IV. Provider business mailing address

227 ANTIQUERA AVE APT 204
CORAL GABLES FL
33134-2922
US

V. Phone/Fax

Practice location:
  • Phone: 786-991-8346
  • Fax:
Mailing address:
  • Phone: 786-991-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25584
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0188547
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCBHCMS.0102578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: