Provider Demographics
NPI:1255197745
Name:MARCELO VARGAS, YANIER LUIS
Entity type:Individual
Prefix:
First Name:YANIER
Middle Name:LUIS
Last Name:MARCELO VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 PALAU DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-5864
Mailing Address - Country:US
Mailing Address - Phone:561-851-2718
Mailing Address - Fax:
Practice Address - Street 1:4051 PALAU DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-5864
Practice Address - Country:US
Practice Address - Phone:561-851-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-327458106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician