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NPI Code Detail

MEDICARE: LISA VEGA

MEDICARE: LISA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1992547962
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA VEGA
Provider Business Mailing Address
First Line : 3121 N OAK STREET EXT
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1099
Country : US
Telephone Number : 800-832-9419
Fax Number :
Provider Business Practice Location Address
First Line : 225 SMITHVILLE CHURCH RD STE 1100
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-9097
Country : US
Telephone Number : 800-832-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2024
Last Update Date : 06/11/2024

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Directions to “ LISA VEGA ” Practice Location

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