Healthcare Provider Details

I. General information

NPI: 1235914664
Provider Name (Legal Business Name): LIZ AMELIA VEGA CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST STE 111
MIAMI LAKES FL
33014-2455
US

IV. Provider business mailing address

1021 NW 36TH AVE APT 2
MIAMI FL
33125-3840
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 305-427-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: