MEDICARE: MAILEN CECILIA VARGAS SAMANIEGO

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	106S00000X	Behavior Technician	25-480876	FL

General Provider Information

NPI Number	:	1093683096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAILEN CECILIA VARGAS SAMANIEGO

Provider Business Mailing Address
First Line	:	9174 ELDRIDGE RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-6205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9174 ELDRIDGE RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-6205
Country	:	US
Telephone Number	:	813-408-9550
Fax Number	:

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

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/30/2025

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