Provider Demographics
NPI:1275812513
Name:DE LA VEGA, XIORELI
Entity Type:Individual
Prefix:
First Name:XIORELI
Middle Name:
Last Name:DE LA VEGA
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 1:660 FALLING WATER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3551
Mailing Address - Country:US
Mailing Address - Phone:954-600-1709
Mailing Address - Fax:954-206-0789
Practice Address - Street 1:660 FALLING WATER RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3551
Practice Address - Country:US
Practice Address - Phone:954-600-1709
Practice Address - Fax:954-206-0789
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst