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General NPI Number Information
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NPI Number | 1538590849
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Entity Type | Organization
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Legal Business Name | VEGA MEDICAL
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 51615 AVENIDA OBREGON
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City | LA QUINTA
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State | CA
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Zip | 92253-3217
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Country | US
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Telephone | 760-393-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 51615 AVENIDA OBREGON
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City | LA QUINTA
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State | CA
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Zip | 92253-3184
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Country | US
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Telephone | 760-393-8494
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Fax |
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Authorized Official
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Title or Position | CHIEF
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Name | DR. JOSE HECTOR VEGA
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Credential | M.D.
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Telephone | 760-393-8494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | G43148
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License Number State | CA
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