Provider Information for 1902963234
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ANTONIO VEGA-PACHECO M.S., L.M.H.C.
Sex: Male
NPI: 1902963234
Last Updated: 2018-04-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902963234 | ||||||||
| Enumeration Date | 2007-01-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3214 HILLSDALE LN KISSIMMEE, FL 34741-7562 United States Phone: 407-518-9161 | Fax: | ||||||||
| Primary Practice Address | 3214 HILLSDALE LN KISSIMMEE, FL 34741-7562 United States Phone: 407-518-9161 | Fax: | ||||||||
| Secondary Practice Address(es) | 201 RUBY AVE | ||||||||
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