Healthcare Provider Details

I. General information

NPI: 1336082890
Provider Name (Legal Business Name): VEGA MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 W 49TH PL STE 701
HIALEAH FL
33012-3158
US

IV. Provider business mailing address

1435 W 49TH PL STE 701
HIALEAH FL
33012-3158
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-2405
  • Fax:
Mailing address:
  • Phone: 305-551-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HENDRICK VEGA MEDINA
Title or Position: OWNER
Credential:
Phone: 305-551-2405