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General NPI Number Information
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NPI Number | 1770733131
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Entity Type | Individual
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Provider Name | DAMARIS VEGA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 120 BROADWAY STE 2043145
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City | KISSIMMEE
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State | FL
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Zip | 34741-5703
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Country | US
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Telephone | 321-321-2066
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Fax | 866-901-7201
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Provider Business Mailing Address
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Address Line | 3145 VIA OTERO DR
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City | KISSIMMEE
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State | FL
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Zip | 34744-4103
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Country | US
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Telephone | 413-351-6470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17099
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License Number State | FL
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