Healthcare Provider Details

I. General information

NPI: 1619032174
Provider Name (Legal Business Name): OMAYRA M. QUIJANO-VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 2ND ST
HARRISBURG PA
17101-1092
US

IV. Provider business mailing address

8 EDWIN LN
PALM COAST FL
32164-6357
US

V. Phone/Fax

Practice location:
  • Phone: 434-248-7508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME109479
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME109479
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberM1299
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: