Healthcare Provider Details

I. General information

NPI: 1790975340
Provider Name (Legal Business Name): RICARDO R VEGA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25109 JEFFERSON AVE STE 125
MURRIETA CA
92562-8118
US

IV. Provider business mailing address

27699 JEFFERSON AVE STE 204
TEMECULA CA
92590-2696
US

V. Phone/Fax

Practice location:
  • Phone: 951-225-1116
  • Fax: 951-225-1103
Mailing address:
  • Phone: 951-225-1116
  • Fax: 951-225-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA65736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA65736
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA65736
License Number StateCA

VIII. Authorized Official

Name: RICARDO R VEGA
Title or Position: OWNER
Credential: MD
Phone: 951-225-1116