Healthcare Provider Details

I. General information

NPI: 1609303775
Provider Name (Legal Business Name): VISTA BEHAVIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 305
DORAL FL
33166-7601
US

IV. Provider business mailing address

3625 NW 82ND AVE STE 305
DORAL FL
33166-7601
US

V. Phone/Fax

Practice location:
  • Phone: 786-592-2004
  • Fax: 786-480-0093
Mailing address:
  • Phone: 786-592-2004
  • Fax: 786-480-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DIANELYS PEREZ
Title or Position: OWNER
Credential:
Phone: 786-592-2004