Provider Demographics
NPI:1609303775
Name:VISTA BEHAVIOR SERVICE LLC
Entity Type:Organization
Organization Name:VISTA BEHAVIOR SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-592-2004
Mailing Address - Street 1:13501 SW 136TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8321
Mailing Address - Country:US
Mailing Address - Phone:786-592-2004
Mailing Address - Fax:786-480-0093
Practice Address - Street 1:13501 SW 136TH ST STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8321
Practice Address - Country:US
Practice Address - Phone:786-592-2004
Practice Address - Fax:786-480-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health