Healthcare Provider Details

I. General information

NPI: 1205462132
Provider Name (Legal Business Name): ANDREW NELSON VEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE STE A110
MIAMI FL
33173-3570
US

IV. Provider business mailing address

7800 SW 87TH AVE STE A110
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-2828
  • Fax:
Mailing address:
  • Phone: 305-596-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME182917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: