Healthcare Provider Details

I. General information

NPI: 1336514116
Provider Name (Legal Business Name): ANGELA PANIAGUA-VEGA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 12/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3063 E PLACITA SANTA LUCIA
TUCSON AZ
85716-0814
US

IV. Provider business mailing address

3063 E PLACITA SANTA LUCIA
TUCSON AZ
85716-0814
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-6400
  • Fax: 520-531-0128
Mailing address:
  • Phone: 520-742-6400
  • Fax: 520-531-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number43541
License Number StateAZ

VIII. Authorized Official

Name: ANGELA PANIAGUA-VEGA
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 520-499-7611