Provider Demographics
NPI:1124870951
Name:MIR VARGAS, NELSA (RBT)
Entity type:Individual
Prefix:
First Name:NELSA
Middle Name:
Last Name:MIR VARGAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SW 131ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1160
Mailing Address - Country:US
Mailing Address - Phone:786-325-6196
Mailing Address - Fax:
Practice Address - Street 1:16650 SW 88TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1283
Practice Address - Country:US
Practice Address - Phone:305-564-1241
Practice Address - Fax:305-901-2048
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician