Healthcare Provider Details

I. General information

NPI: 1578639431
Provider Name (Legal Business Name): ALBERTO LUNA VEGA SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 3RD AVE 89TH ST NY NY 10128 2146 BEVERLY RD
BKLYN NY
11226
US

IV. Provider business mailing address

1760 2ND AVE APT 17B
NEW YORK NY
10128-5392
US

V. Phone/Fax

Practice location:
  • Phone: 212-369-9620
  • Fax:
Mailing address:
  • Phone: 212-369-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number171809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: