MEDICARE: MR. MARIO VEGA MS

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	103K00000X	Behavior Analyst	BCBA (1-10-6944)	CA

General Provider Information

NPI Number	:	1417204603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO VEGA MS

Provider Business Mailing Address
First Line	:	2922 DE LA VINA ST
Second Line	:	STE C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	323-695-7273
Fax Number	:	866-246-1018

Provider Business Practice Location Address
First Line	:	2922 DE LA VINA ST
Second Line	:	STE C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	323-695-7273
Fax Number	:	866-246-1018

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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Directions to “ MR. MARIO VEGA MS” Practice Location

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