Provider Demographics
NPI:1053082016
Name:VEGA MUNOZ, KENIA G
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:G
Last Name:VEGA MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 SW 24TH ST APT 114
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8070
Mailing Address - Country:US
Mailing Address - Phone:305-776-2836
Mailing Address - Fax:
Practice Address - Street 1:9615 SW 24TH ST APT 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8070
Practice Address - Country:US
Practice Address - Phone:305-776-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL20-11-7194106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician