Healthcare Provider Details

I. General information

NPI: 1669403358
Provider Name (Legal Business Name): PAULA XIOMARA VEGA PRECIDENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 NW SOUTH RIVER DR
MEDLEY FL
33166-7451
US

IV. Provider business mailing address

8264 NW SOUTH RIVER DR
MEDLEY FL
33166-7451
US

V. Phone/Fax

Practice location:
  • Phone: 305-885-0740
  • Fax: 305-332-5459
Mailing address:
  • Phone: 305-885-0740
  • Fax: 305-332-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number04548
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORF 148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: