Provider Demographics
NPI:1376069120
Name:VEGA MIR, MARGARITA JUANA
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:JUANA
Last Name:VEGA MIR
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 1:109 LAKE PINE CIR APT C-2
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5104
Mailing Address - Country:US
Mailing Address - Phone:301-312-7238
Mailing Address - Fax:
Practice Address - Street 1:109 LAKE PINE CIR APT C-2
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5104
Practice Address - Country:US
Practice Address - Phone:301-312-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FLRBT-18-62243106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other