=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669737821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINI VEGA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2012
-----------------------------------------------------
Last Update Date | 07/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 S BISCAYNE BLVD APT UPH00
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-209-0910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10534
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33101-0534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TRINI VEGA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-209-0910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME103751
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------