Healthcare Provider Details

I. General information

NPI: 1982607750
Provider Name (Legal Business Name): RICARDO RAFAEL VEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE STE 204
TEMECULA CA
92590
US

IV. Provider business mailing address

27699 JEFFERSON AVE STE 204
TEMECULA CA
92590-2696
US

V. Phone/Fax

Practice location:
  • Phone: 951-225-1116
  • Fax: 951-225-1103
Mailing address:
  • Phone: 951-225-1116
  • Fax: 951-225-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA65736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA65736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: