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NPI Code Detail

MEDICARE: MARIANA VILLEGAS VENEGAS

MEDICARE: MARIANA VILLEGAS VENEGAS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1629649645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANA VILLEGAS VENEGAS
Provider Business Mailing Address
First Line : 729 REVERE ST
Second Line :
City : CANTON
State : MI
Zip : 48188-2895
Country : US
Telephone Number : 734-730-9162
Fax Number :
Provider Business Practice Location Address
First Line : 23800 NORTHWESTERN HWY STE 190L
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-7740
Country : US
Telephone Number : 248-900-2166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 12/01/2025

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Directions to “ MARIANA VILLEGAS VENEGAS ” Practice Location

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