Healthcare Provider Details

I. General information

NPI: 1457854705
Provider Name (Legal Business Name): JOSHUA JESUS VEGA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSHUA JESUS VEGA PA-C

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

60 ELDERBERRY ST
SELMA NC
27576-3264
US

V. Phone/Fax

Practice location:
  • Phone: 772-359-4373
  • Fax:
Mailing address:
  • Phone: 772-359-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: