Healthcare Provider Details

I. General information

NPI: 1801695176
Provider Name (Legal Business Name): ROBERT RAY VEGA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 N GREGORY AVE
FRESNO CA
93722-0456
US

IV. Provider business mailing address

4460 N GREGORY AVE
FRESNO CA
93722-0456
US

V. Phone/Fax

Practice location:
  • Phone: 559-579-9777
  • Fax:
Mailing address:
  • Phone: 559-287-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: