Healthcare Provider Details

I. General information

NPI: 1598136749
Provider Name (Legal Business Name): GEORGINA VEGA-CARMONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46883 MONROE ST
INDIO CA
92201-6768
US

IV. Provider business mailing address

46883 MONROE ST
INDIO CA
92201-6768
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-9000
  • Fax:
Mailing address:
  • Phone: 760-398-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT135987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: