Healthcare Provider Details

I. General information

NPI: 1245008226
Provider Name (Legal Business Name): KIRENIA DORISLEY VILAR VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12831 SW 43RD DR APT 14812831
MIAMI FL
33175-4181
US

IV. Provider business mailing address

12831 SW 43RD DR APT 14812831
MIAMI FL
33175-4181
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-5290
  • Fax:
Mailing address:
  • Phone: 786-399-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-309927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: