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NPI Code Detail

MEDICARE: BIANCA T VEGA PA-C

MEDICARE: BIANCA T VEGA PA-C
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
1363A00000XPhysician AssistantPA9104015FL

General Provider Information

NPI Number : 1124174511
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIANCA T VEGA PA-C
Provider Business Mailing Address
First Line : 1608 TOWN CENTER BLVD STE A
Second Line :
City : WESTON
State : FL
Zip : 33326-3639
Country : US
Telephone Number : 305-218-6965
Fax Number :
Provider Business Practice Location Address
First Line : 1345 NE 4TH AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-1031
Country : US
Telephone Number : 954-458-1199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 05/03/2024

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Directions to “ BIANCA T VEGA PA-C” Practice Location

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