Healthcare Provider Details

I. General information

NPI: 1215967864
Provider Name (Legal Business Name): ANGEL P VEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 SHELDON RD
TAMPA FL
33615-3532
US

IV. Provider business mailing address

PO BOX 82969
TAMPA FL
33682-2969
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5320
  • Fax: 813-405-3709
Mailing address:
  • Phone: 813-866-0930
  • Fax: 813-405-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME43544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: