Provider Demographics
NPI:1396016341
Name:VERGARA, DIANA C
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:VERGARA
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 1:1900 N BAYSHORE DR
Mailing Address - Street 2:3004
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3001
Mailing Address - Country:US
Mailing Address - Phone:786-457-7327
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR
Practice Address - Street 2:3004
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3001
Practice Address - Country:US
Practice Address - Phone:786-457-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst