MEDICARE: ANELHI 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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1073284725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANELHI VEGA

Provider Business Mailing Address
First Line	:	4801 W 1ST ST SPC 47
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 W 1ST ST SPC 47
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3138
Country	:	US
Telephone Number	:	714-717-1021
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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Directions to “ ANELHI VEGA ” Practice Location

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