Healthcare Provider Details

I. General information

NPI: 1528420932
Provider Name (Legal Business Name): MARIA ROSE VACHA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA VACHA D.O.

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10060 REGENCY CIR
OMAHA NE
68114-3732
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-1405
  • Fax: 402-354-1599
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1999
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: