Healthcare Provider Details

I. General information

NPI: 1811516719
Provider Name (Legal Business Name): JESUS AVILA VEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 S STERLING ST STE 530
MORGANTON NC
28655-4093
US

IV. Provider business mailing address

2209 S STERLING ST STE 530
MORGANTON NC
28655-4093
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2026-04368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: