MEDICARE: ANDREA M VEGA-BREAUX

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	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	367500000X	Certified Registered Nurse Anesthetist	95002773	CA

General Provider Information

NPI Number	:	1588554687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA M VEGA-BREAUX

Provider Business Mailing Address
First Line	:	3433 DELTA QUEEN AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-9786
Country	:	US
Telephone Number	:	831-261-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 DELTA QUEEN AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-9786
Country	:	US
Telephone Number	:	831-261-1671
Fax Number	:

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

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	01/12/2026

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Directions to “ ANDREA M VEGA-BREAUX ” Practice Location

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