MEDICARE: DR. ERNESTO JOSUE VEGA PT,DPT,CLT

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	225100000X	Physical Therapist	37918	CA

General Provider Information

NPI Number	:	1013472315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO JOSUE VEGA PT,DPT,CLT

Provider Business Mailing Address
First Line	:	526 SAN DIEGO ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 SAN DIEGO ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1773
Country	:	US
Telephone Number	:	805-867-3110
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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