Provider Demographics
NPI:1124832910
Name:VEGA, MARIANELA (RBT-24-366458)
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:RBT-24-366458
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 SW 133RD AVENUE RD APT 420
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4587
Mailing Address - Country:US
Mailing Address - Phone:786-913-9577
Mailing Address - Fax:
Practice Address - Street 1:8500 SW 133RD AVENUE RD APT 420
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4587
Practice Address - Country:US
Practice Address - Phone:786-913-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-366458106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty