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NPI Code Detail

MEDICARE: DR. AGUSTIN VEGA SANTIAGO M.D.

MEDICARE: DR. AGUSTIN VEGA SANTIAGO M.D.
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
1207R00000XInternal Medicine PhysicianME 127343FL
2208D00000XGeneral Practice Physician18052PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124322193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AGUSTIN VEGA SANTIAGO M.D.
Provider Business Mailing Address
First Line : 4691 OLD CANOE CREEK RD
Second Line :
City : SAINT CLOUD
State : FL
Zip : 34769-1550
Country : US
Telephone Number : 407-498-4015
Fax Number :
Provider Business Practice Location Address
First Line : 4691 OLD CANOE CREEK RD
Second Line :
City : SAINT CLOUD
State : FL
Zip : 34769-1550
Country : US
Telephone Number : 407-498-4015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2011
Last Update Date : 12/05/2022

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