Healthcare Provider Details

I. General information

NPI: 1871906743
Provider Name (Legal Business Name): DANIELLA VEGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE STE 210
FARMINGTON CT
06032-1944
US

IV. Provider business mailing address

399 FARMINGTON AVE STE 210
FARMINGTON CT
06032-1944
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7338
  • Fax:
Mailing address:
  • Phone: 860-548-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number70593
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: