MEDICARE: MARIA TERESA VEGA DIAZ BCBA

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
2	103K00000X	Behavior Analyst	1-20-46268	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457861163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA TERESA VEGA DIAZ BCBA

Provider Business Mailing Address
First Line	:	1028 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2352
Country	:	US
Telephone Number	:	561-909-8980
Fax Number	:	561-429-6889

Provider Business Practice Location Address
First Line	:	1028 N FEDERAL HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2352
Country	:	US
Telephone Number	:	561-909-8980
Fax Number	:	561-429-6889

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

Provider Enumeration Date	:	10/08/2017
Last Update Date	:	01/27/2025

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