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General NPI Number Information
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NPI Number | 1285664151
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Entity Type | Individual
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Provider Name | GILBERT G VEGA PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1962 E JUAN SANCHEZ BLVD STE C2
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City | SAN LUIS
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State | AZ
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Zip | 85336-0478
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Country | US
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Telephone | 928-627-4825
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | YUMA
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State | AZ
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Zip | 85366-2329
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Country | US
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Telephone | 928-342-6500
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Fax | 928-627-9105
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3434
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3434
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License Number State | AZ
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