Provider Demographics
NPI:1689425746
Name:PENA VARGAS, JULY ALEXANDRA
Entity Type:Individual
Prefix:
First Name:JULY
Middle Name:ALEXANDRA
Last Name:PENA VARGAS
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 1:1477 WOODCREST RD N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5746
Mailing Address - Country:US
Mailing Address - Phone:561-951-8236
Mailing Address - Fax:
Practice Address - Street 1:1477 WOODCREST RD N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-5746
Practice Address - Country:US
Practice Address - Phone:561-951-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty