Provider Demographics
NPI:1326748898
Name:VEGA, YULIET
Entity Type:Individual
Prefix:MRS
First Name:YULIET
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YULIET
Other - Middle Name:
Other - Last Name:ALFONSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9620 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1511
Mailing Address - Country:US
Mailing Address - Phone:786-546-0351
Mailing Address - Fax:
Practice Address - Street 1:14505 COMMERCE WAY STE 750
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1514
Practice Address - Country:US
Practice Address - Phone:305-362-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician