Healthcare Provider Details

I. General information

NPI: 1083571103
Provider Name (Legal Business Name): MRS. MARTHA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 W COMMONWEALTH AVE STE C
FULLERTON CA
92832-1612
US

IV. Provider business mailing address

11902 167TH ST
ARTESIA CA
90701-1820
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-4274
  • Fax: 714-879-2274
Mailing address:
  • Phone: 323-667-6842
  • Fax: 323-667-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: