Provider Demographics
NPI:1659910479
Name:VEGA, SWEETY JACQUELINEE
Entity Type:Individual
Prefix:
First Name:SWEETY
Middle Name:JACQUELINEE
Last Name:VEGA
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 1:10742 S CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3929
Mailing Address - Country:US
Mailing Address - Phone:909-728-7227
Mailing Address - Fax:
Practice Address - Street 1:10742 S CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3929
Practice Address - Country:US
Practice Address - Phone:909-728-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician