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NPI Code Detail

MEDICARE: STEPHANIE DE LA VEGA

MEDICARE: STEPHANIE DE LA VEGA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS43414FL

General Provider Information

NPI Number : 1053736918
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE DE LA VEGA
Provider Business Mailing Address
First Line : 19501 NW 27TH AVE
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33056-2521
Country : US
Telephone Number : 305-622-6668
Fax Number : 305-622-7927
Provider Business Practice Location Address
First Line : 19501 NW 27TH AVE
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33056-2521
Country : US
Telephone Number : 305-622-6668
Fax Number : 305-622-7927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2014
Last Update Date : 02/28/2014

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Directions to “ STEPHANIE DE LA VEGA ” Practice Location

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