Healthcare Provider Details

I. General information

NPI: 1801467824
Provider Name (Legal Business Name): ANDREA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 BALBOA AVE # 543
SAN DIEGO CA
92117-5504
US

IV. Provider business mailing address

4231 BALBOA AVE # 543
SAN DIEGO CA
92117-5504
US

V. Phone/Fax

Practice location:
  • Phone: 619-356-8438
  • Fax:
Mailing address:
  • Phone: 619-719-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: