Provider Demographics
NPI:1427556547
Name:DE LA VEGA, AILEN (CBHCMS)
Entity Type:Individual
Prefix:
First Name:AILEN
Middle Name:
Last Name:DE LA VEGA
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 107TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2746
Mailing Address - Country:US
Mailing Address - Phone:786-542-5043
Mailing Address - Fax:786-542-5049
Practice Address - Street 1:1400 NW 107TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2746
Practice Address - Country:US
Practice Address - Phone:786-436-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker