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General NPI Number Information
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NPI Number | 1750574190
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Entity Type | Individual
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Provider Name | EDISSON 'XAVIER' VEGA-CORDOVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 608
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City | HIALEAH
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State | FL
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Zip | 33016-1824
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Country | US
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Telephone | 305-557-4016
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Fax | 305-828-0670
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Provider Business Mailing Address
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Address Line | 15280 NW 79TH CT STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5873
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Country | US
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Telephone | 305-558-3724
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Fax | 786-907-4485
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 125-053608
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 45642
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME134284
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License Number State | FL
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