Healthcare Provider Details

I. General information

NPI: 1417762782
Provider Name (Legal Business Name): CARLOS VESGA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10185 CALIFORNIA AVE
RIVERSIDE CA
92503-2849
US

IV. Provider business mailing address

10185 CALIFORNIA AVE
RIVERSIDE CA
92503-2849
US

V. Phone/Fax

Practice location:
  • Phone: 626-646-8796
  • Fax:
Mailing address:
  • Phone: 626-646-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: