Healthcare Provider Details

I. General information

NPI: 1518897917
Provider Name (Legal Business Name): GEORGE VEGA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
WEST READING PA
19611-2143
US

IV. Provider business mailing address

420 S 5TH AVE
WEST READING PA
19611-2143
US

V. Phone/Fax

Practice location:
  • Phone: 833-348-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT025447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: