Provider Demographics
NPI:1295497881
Name:VEGA, FELIPE ALFONSO (RBT)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:ALFONSO
Last Name:VEGA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15039 SW 127TH CIRCLE PL N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6345
Mailing Address - Country:US
Mailing Address - Phone:786-606-7141
Mailing Address - Fax:
Practice Address - Street 1:14754 SW 178TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-7709
Practice Address - Country:US
Practice Address - Phone:786-419-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-183445106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician