Provider Demographics
NPI:1962900506
Name:VEGA, RODOLFO (BEHAVIOR ASSISTANT)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 SW 71ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2314
Mailing Address - Country:US
Mailing Address - Phone:786-560-8588
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2314
Practice Address - Country:US
Practice Address - Phone:786-560-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other