Provider Demographics
NPI:1528870730
Name:TAVAREZ VARGAS, JEISEL
Entity type:Individual
Prefix:
First Name:JEISEL
Middle Name:
Last Name:TAVAREZ VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 SW 50TH ST APT 145
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5862
Mailing Address - Country:US
Mailing Address - Phone:781-521-8999
Mailing Address - Fax:
Practice Address - Street 1:12430 SW 50TH ST APT 145
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5862
Practice Address - Country:US
Practice Address - Phone:781-521-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist