Provider Demographics
NPI:1831673466
Name:VARGAS, YAIMARA AMELIA (BEHAVIOR THECNICHICA)
Entity Type:Individual
Prefix:MS
First Name:YAIMARA
Middle Name:AMELIA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:BEHAVIOR THECNICHICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1214
Mailing Address - Country:US
Mailing Address - Phone:786-486-6801
Mailing Address - Fax:
Practice Address - Street 1:11022 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1214
Practice Address - Country:US
Practice Address - Phone:786-486-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-121026106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty