Provider Demographics
NPI:1851164354
Name:OBREGON VASQUEZ, REBEKA TAIZ
Entity Type:Individual
Prefix:
First Name:REBEKA
Middle Name:TAIZ
Last Name:OBREGON VASQUEZ
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 1:3276 W 100TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2101
Mailing Address - Country:US
Mailing Address - Phone:786-318-2004
Mailing Address - Fax:
Practice Address - Street 1:3276 W 100TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2101
Practice Address - Country:US
Practice Address - Phone:786-318-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-290230106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician