Healthcare Provider Details

I. General information

NPI: 1104739598
Provider Name (Legal Business Name): LUIS JOEL VIGO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18520 NW 49TH CT
OPA LOCKA FL
33055-2454
US

IV. Provider business mailing address

18520 NW 49TH CT
OPA LOCKA FL
33055-2454
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-2773
  • Fax:
Mailing address:
  • Phone: 786-316-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-148867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: