Healthcare Provider Details

I. General information

NPI: 1053242115
Provider Name (Legal Business Name): DANIELA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 SW 39TH ST APT B206
DAVIE FL
33314-2464
US

IV. Provider business mailing address

6944 SW 39TH ST APT B206
DAVIE FL
33314-2464
US

V. Phone/Fax

Practice location:
  • Phone: 954-909-9505
  • Fax:
Mailing address:
  • Phone: 954-909-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: