Healthcare Provider Details

I. General information

NPI: 1184804544
Provider Name (Legal Business Name): MISS ZIRAMA CAROLINA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TULLY RD SUITE 304
SAN JOSE CA
95122-3055
US

IV. Provider business mailing address

5356 MONTEREY RD APT 3
SAN JOSE CA
95111-4225
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-3900
  • Fax:
Mailing address:
  • Phone: 408-360-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: