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General NPI Number Information
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NPI Number | 1548978059
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Entity Type | Organization
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Legal Business Name | TH VEGA BEHAVIORAL CORP
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 100 NE 15TH ST STE 101A
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City | HOMESTEAD
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State | FL
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Zip | 33030-4564
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Country | US
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Telephone | 786-547-7103
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Fax | 786-601-2507
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Provider Business Mailing Address
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Address Line | 10876 SW 229TH ST
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City | MIAMI
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State | FL
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Zip | 33170-7517
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Country | US
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Telephone | 786-370-2216
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DIANA HERNANDEZ DE LA GUARDIA
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Credential |
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Telephone | 786-410-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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