MEDICARE: ANA ISABELLA VEGA GONZALEZ

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
1	2355S0801X	Speech-Language Assistant	SLPA17084	AZ

General Provider Information

NPI Number	:	1407709793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA ISABELLA VEGA GONZALEZ

Provider Business Mailing Address
First Line	:	333 E COMMONWEALTH AVE APT 245
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-5578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1744 S VAL VISTA DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-7362
Country	:	US
Telephone Number	:	480-250-3760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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