Healthcare Provider Details

I. General information

NPI: 1356879845
Provider Name (Legal Business Name): OMAR GONZALEZ-VEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 CLAREMONT WAY
NAPA CA
94558-3300
US

IV. Provider business mailing address

2561 MARIN ST
NAPA CA
94558-4809
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-2500
  • Fax:
Mailing address:
  • Phone: 707-260-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU6722
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: