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General NPI Number Information
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NPI Number | 1811449697
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Entity Type | Organization
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Legal Business Name | WEST CAYUGA MEDICINE PC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 257 W CAYUGA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2439
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Country | US
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Telephone | 267-368-6953
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Fax | 215-621-6940
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Provider Business Mailing Address
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Address Line | 257 W CAYUGA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2439
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Country | US
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Telephone | 267-368-6953
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Fax | 215-621-6940
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Authorized Official
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Title or Position | OWNER & CEO
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Name | FABIAN A VENGOECHEA
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Credential |
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Telephone | 267-368-6953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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