Healthcare Provider Details

I. General information

NPI: 1710187786
Provider Name (Legal Business Name): GILBERTO VEGA-MARTINEZ MD, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 N RIDGEWOOD AVE
EDGEWATER FL
32132-1734
US

IV. Provider business mailing address

3026 MELETO BLVD
NEW SMYRNA BEACH FL
32168-6513
US

V. Phone/Fax

Practice location:
  • Phone: 386-427-4868
  • Fax: 386-427-6350
Mailing address:
  • Phone: 407-453-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME152251
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: