Provider Demographics
NPI:1124658695
Name:VEGA, DAILYN
Entity type:Individual
Prefix:
First Name:DAILYN
Middle Name:
Last Name:VEGA
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 1:17884 SW 107TH AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5182
Mailing Address - Country:US
Mailing Address - Phone:786-878-2099
Mailing Address - Fax:
Practice Address - Street 1:12963 W OKEECHOBEE RD UNIT 3
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-6055
Practice Address - Country:US
Practice Address - Phone:786-536-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS0102690171M00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCMS0102690OtherFLORIDA CERTIFICATION BOARD CASE MANAGER SUPERVISOR