Provider Demographics
NPI:1053029397
Name:VEGA, NATHALIE DANYELLE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:DANYELLE
Last Name:VEGA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 FORREST DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7261
Mailing Address - Country:US
Mailing Address - Phone:305-793-0048
Mailing Address - Fax:
Practice Address - Street 1:688 FORREST DR APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7261
Practice Address - Country:US
Practice Address - Phone:305-793-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist