Provider Demographics
NPI:1528543246
Name:VEGA VALLE, JOSSY GISLANE
Entity Type:Individual
Prefix:
First Name:JOSSY
Middle Name:GISLANE
Last Name:VEGA VALLE
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 1:2411 ACADEMY CIR E APT 104
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8491
Mailing Address - Country:US
Mailing Address - Phone:787-237-2381
Mailing Address - Fax:
Practice Address - Street 1:2411 ACADEMY CIR E APT 104
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-8491
Practice Address - Country:US
Practice Address - Phone:787-237-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician