MEDICARE: NELSON VEGA MD

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

General Provider Information

NPI Number	:	1558751123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELSON VEGA MD

Provider Business Mailing Address
First Line	:	3837 SW 99TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3907
Country	:	US
Telephone Number	:	305-552-1717
Fax Number	:	305-552-1782

Provider Business Practice Location Address
First Line	:	3837 SW 99TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3907
Country	:	US
Telephone Number	:	305-552-1717
Fax Number	:	305-552-1782

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. NELSON VEGA
Credential	:	M.D.
Telephone Number	:	305-552-1717

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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