MEDICARE: MARINA LEE VARGAS GARCIA

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	SI3841	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SI3841	OTHER	FL	SLPA LICENSE

General Provider Information

NPI Number	:	1407329188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA LEE VARGAS GARCIA

Provider Business Mailing Address
First Line	:	910 INNOVATION WAY APT 100
Second Line	:
City	:	ALTAMONTE SPG
State	:	FL
Zip	:	32714-1874
Country	:	US
Telephone Number	:	787-709-1078
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-5745
Country	:	US
Telephone Number	:	321-445-1287
Fax Number	:	407-386-7448

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

Provider Enumeration Date	:	01/06/2019
Last Update Date	:	01/06/2019

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