MEDICARE: MR. ARIEL VEGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	MA 63385	FL

General Provider Information

NPI Number	:	1003195561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIEL VEGA

Provider Business Mailing Address
First Line	:	618 SW 3RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1985
Country	:	US
Telephone Number	:	239-242-2202
Fax Number	:	239-242-2220

Provider Business Practice Location Address
First Line	:	618 SW 3RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1985
Country	:	US
Telephone Number	:	239-242-2202
Fax Number	:	239-242-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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Directions to “ MR. ARIEL VEGA ” Practice Location

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