Provider Demographics
NPI:1811593494
Name:VEGA BORREGO, YAILI (CRDH)
Entity Type:Individual
Prefix:
First Name:YAILI
Middle Name:
Last Name:VEGA BORREGO
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12123 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2924
Mailing Address - Country:US
Mailing Address - Phone:727-379-9250
Mailing Address - Fax:
Practice Address - Street 1:12123 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2924
Practice Address - Country:US
Practice Address - Phone:727-379-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25183124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist