Provider Demographics
NPI:1972182004
Name:VEGA PARRA, LUISA MARIA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:MARIA
Last Name:VEGA PARRA
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 1:7383 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1426
Mailing Address - Country:US
Mailing Address - Phone:789-458-6042
Mailing Address - Fax:
Practice Address - Street 1:8100 NW 155TH ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5865
Practice Address - Country:US
Practice Address - Phone:786-458-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL20-116932106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician