Provider Demographics
NPI:1912747981
Name:GUERRA VEGA, CESAR FERNANDO (RBT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:FERNANDO
Last Name:GUERRA VEGA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14948 SW 283RD ST APT 108
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1568
Mailing Address - Country:US
Mailing Address - Phone:786-505-3617
Mailing Address - Fax:
Practice Address - Street 1:14948 SW 283RD ST APT 108
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1568
Practice Address - Country:US
Practice Address - Phone:786-505-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-350123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician