Healthcare Provider Details

I. General information

NPI: 1891879110
Provider Name (Legal Business Name): HILDA EVERLIDIS VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PLYMOUTH AVE
DELAND FL
32720-2753
US

IV. Provider business mailing address

201 W PLYMOUTH AVE
DELAND FL
32720-2753
US

V. Phone/Fax

Practice location:
  • Phone: 386-873-2963
  • Fax: 386-873-2786
Mailing address:
  • Phone: 386-873-2963
  • Fax: 386-873-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME70328
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME70328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: