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NPI Code Detail

MEDICARE: MRS. COLLEEN ANNE VEGA C.N.S.

MEDICARE: MRS. COLLEEN ANNE VEGA C.N.S.
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
1364S00000XClinical Nurse Specialist3683CA

General Provider Information

NPI Number : 1578834305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN ANNE VEGA C.N.S.
Provider Business Mailing Address
First Line : 1464 MARCIA AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95125-4760
Country : US
Telephone Number : 831-359-2405
Fax Number :
Provider Business Practice Location Address
First Line : 1464 MARCIA AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95125-4760
Country : US
Telephone Number : 831-359-2405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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