MEDICARE: DR. HEATHER LEIGH ELIZONDO VEGA M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	055126	GA
2	2080A0000X	Pediatric Adolescent Medicine Physician	ME 114824	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457341414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER LEIGH ELIZONDO VEGA M.D.

Provider Business Mailing Address
First Line	:	15502 STONEYBROOK WEST PKWY
Second Line	:	SUITE 2-108
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4767
Country	:	US
Telephone Number	:	210-287-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	15502 STONEYBROOK WEST PKWY
Second Line	:	SUITE 2-108
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4767
Country	:	US
Telephone Number	:	210-287-7243
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/29/2013

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Directions to “ DR. HEATHER LEIGH ELIZONDO VEGA M.D.” Practice Location

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