Provider Demographics
NPI:1083149694
Name:VERGEL, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:VERGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9147 NW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4581
Mailing Address - Country:US
Mailing Address - Phone:786-223-0165
Mailing Address - Fax:
Practice Address - Street 1:9147 NW 112TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4581
Practice Address - Country:US
Practice Address - Phone:786-223-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant