MEDICARE: MARIO VERGEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1083149694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO VERGEL

Provider Business Mailing Address
First Line	:	9147 NW 112TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4581
Country	:	US
Telephone Number	:	786-223-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	9147 NW 112TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4581
Country	:	US
Telephone Number	:	786-223-0165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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Directions to “ MARIO VERGEL ” Practice Location

Language	Start Address	Practice Location

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