Healthcare Provider Details

I. General information

NPI: 1982988317
Provider Name (Legal Business Name): CHARMENE MARJORIE VEGA M.S., MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAMA VEGA

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10019 ALLSPICE ROSE CT
BAKERSFIELD CA
93311-3763
US

IV. Provider business mailing address

10019 ALLSPICE ROSE CT
BAKERSFIELD CA
93311-3763
US

V. Phone/Fax

Practice location:
  • Phone: 616-532-8342
  • Fax:
Mailing address:
  • Phone: 661-532-8342
  • Fax: 661-864-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: