Provider Demographics
NPI:1396545430
Name:VARGAS, DANIELLA M
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:M
Last Name:VARGAS
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 1:2861 CARAMBOLA CIR S
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2578
Mailing Address - Country:US
Mailing Address - Phone:952-294-5868
Mailing Address - Fax:
Practice Address - Street 1:3901 NW 79TH AVE STE 246
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6502
Practice Address - Country:US
Practice Address - Phone:786-418-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-7253-859347106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician