Healthcare Provider Details

I. General information

NPI: 1477015493
Provider Name (Legal Business Name): SAMUEL ALFONSO VEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 CRENSHAW RD STE 100
PASADENA TX
77505-3139
US

IV. Provider business mailing address

5050 CRENSHAW RD STE 100
PASADENA TX
77505-3139
US

V. Phone/Fax

Practice location:
  • Phone: 832-399-4120
  • Fax: 832-399-4121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberT0971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: