Individual
BRENDA LIZ DE JESUS VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP AND RPT
Contact information
Practice address
6062 TIVOLI GARDENS BLVD, ORLANDO, FL 32829-7702
(407) 779-2419
Mailing address
6062 TIVOLI GARDENS BLVD, ORLANDO, FL 32829-7702
(407) 779-2419
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1043
PR
235Z00000X
Speech-Language Pathologist
Primary
SA12884
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011132400
—
FL
Enumeration date
12/24/2008
Last updated
02/03/2015
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