MEDICARE: KRYSTINA VEGA

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	25-414401	FL

General Provider Information

NPI Number	:	1457142952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINA VEGA

Provider Business Mailing Address
First Line	:	18668 NW 78TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5245
Country	:	US
Telephone Number	:	786-715-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	18668 NW 78TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5245
Country	:	US
Telephone Number	:	786-715-9405
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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Directions to “ KRYSTINA VEGA ” Practice Location

Language	Start Address	Practice Location

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