Provider Demographics
NPI:1679083398
Name:VARGAS TAMAYO, JULIA YUDELKYS
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:YUDELKYS
Last Name:VARGAS TAMAYO
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 1:1110 SW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2829
Mailing Address - Country:US
Mailing Address - Phone:786-328-6456
Mailing Address - Fax:
Practice Address - Street 1:1110 SW 31ST AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2829
Practice Address - Country:US
Practice Address - Phone:786-328-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician