Healthcare Provider Details

I. General information

NPI: 1659315638
Provider Name (Legal Business Name): JULIO L. VEGA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST
MIAMI FL
33142
US

IV. Provider business mailing address

11031 NE 6TH AVE
MIAMI FL
33161-7182
US

V. Phone/Fax

Practice location:
  • Phone: 786-433-8633
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-757-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: