Provider Demographics
NPI:1598576126
Name:AMBRIZ-VEGA, NATALIA JAYLIN
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:JAYLIN
Last Name:AMBRIZ-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 1:543 CARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7394
Mailing Address - Country:US
Mailing Address - Phone:219-386-0020
Mailing Address - Fax:
Practice Address - Street 1:7554 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6672
Practice Address - Country:US
Practice Address - Phone:219-501-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician