Healthcare Provider Details

I. General information

NPI: 1477485787
Provider Name (Legal Business Name): VIGOA AUTISM, BEHAVIORAL & HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17313 NW 63RD AVE
HIALEAH FL
33015-4470
US

IV. Provider business mailing address

17313 NW 63RD AVE
HIALEAH FL
33015-4470
US

V. Phone/Fax

Practice location:
  • Phone: 786-450-8270
  • Fax:
Mailing address:
  • Phone: 786-450-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTONY GONZALEZ VIGOA
Title or Position: MANAGING MEMBER
Credential: ARNP
Phone: 786-450-8270