Healthcare Provider Details

I. General information

NPI: 1164356499
Provider Name (Legal Business Name): DIOBER VALLEJO VEGA PHLEBOTOMIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 NW 47TH ST
MIAMI FL
33142-3382
US

IV. Provider business mailing address

3290 NW 47TH ST
MIAMI FL
33142-3382
US

V. Phone/Fax

Practice location:
  • Phone: 786-650-9426
  • Fax:
Mailing address:
  • Phone: 786-650-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: