MEDICARE: MISS GEORLIZA VEGA PA

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	363A00000X	Physician Assistant	PAT9107452	FL

General Provider Information

NPI Number	:	1023439189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GEORLIZA VEGA PA

Provider Business Mailing Address
First Line	:	7975 NW 154TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5863
Country	:	US
Telephone Number	:	305-556-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	7975 NW 154TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5863
Country	:	US
Telephone Number	:	305-556-5671
Fax Number	:

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

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	03/31/2015

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Directions to “ MISS GEORLIZA VEGA PA” Practice Location

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