Healthcare Provider Details

I. General information

NPI: 1497737852
Provider Name (Legal Business Name): MANUEL VEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 W FLAGLER ST
CORAL GABLES FL
33134-1601
US

IV. Provider business mailing address

6100 BLUE LAGOON DRIVE SUITE 400
MIAMI FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-3400
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-757-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME54056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: