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General NPI Number Information
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NPI Number | 1881906980
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Entity Type | Organization
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Legal Business Name | VEGA THERAPEUTICS LLC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 2415 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3301
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Country | US
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Telephone | 956-271-4706
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Fax | 956-271-4708
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Provider Business Mailing Address
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Address Line | 2415 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3241
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Country | US
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Telephone | 956-271-4706
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Fax | 956-271-4708
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Authorized Official
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Title or Position | OWNER
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Name | JUANITA VEGA
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Credential | OTR, CHT
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Telephone | 956-271-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 103534
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License Number State | TX
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