=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740057611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEATRIZ VEGA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 12/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2514 HOLLYWOOD BLVD STE 205
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-6637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-400-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1680 W 60TH ST APT 2
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-6816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-817-9505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 23-307823
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------