Provider Demographics
NPI:1801612627
Name:SORI VEGA, MARCOS WILLIANS
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:WILLIANS
Last Name:SORI VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 NW 174TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4526
Mailing Address - Country:US
Mailing Address - Phone:305-720-3948
Mailing Address - Fax:
Practice Address - Street 1:6131 NW 174TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4526
Practice Address - Country:US
Practice Address - Phone:305-720-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS612-559-03-067-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician