Healthcare Provider Details

I. General information

NPI: 1902646813
Provider Name (Legal Business Name): ANA LUISA DELA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 FREMONT BLVD
SEASIDE CA
93955-3132
US

IV. Provider business mailing address

19637 JUNIPER LOOP
MORGAN HILL CA
95037-9292
US

V. Phone/Fax

Practice location:
  • Phone: 831-296-1333
  • Fax:
Mailing address:
  • Phone: 510-468-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: