MEDICARE: VIGOA AUTISM, BEHAVIORAL & HEALTHCARE SERVICES, LLC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1477485787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIGOA AUTISM, BEHAVIORAL & HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	17313 NW 63RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4470
Country	:	US
Telephone Number	:	786-450-8270
Fax Number	:

Provider Business Practice Location Address
First Line	:	17313 NW 63RD AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4470
Country	:	US
Telephone Number	:	786-450-8270
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ANTONY GONZALEZ VIGOA
Credential	:	ARNP
Telephone Number	:	786-450-8270

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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