Healthcare Provider Details

I. General information

NPI: 1235148156
Provider Name (Legal Business Name): NELSON VEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 SW 99TH AVE
MIAMI FL
33165-3907
US

IV. Provider business mailing address

3837 SW 99TH AVE
MIAMI FL
33165-3907
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-1717
  • Fax: 305-552-1782
Mailing address:
  • Phone: 305-552-1717
  • Fax: 305-552-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME55885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: