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NPI Code Detail

MEDICARE: EXAL VEGA

MEDICARE: EXAL 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
1175T00000XPeer SpecialistMPSS-SWAGICCA
2225400000XRehabilitation PractitionerCA

General Provider Information

NPI Number : 1295600849
Entity Type Code : Individual
Provider Name (Legal Business Name) : EXAL VEGA
Provider Business Mailing Address
First Line : 1364 KATRINA LN
Second Line :
City : SAN JACINTO
State : CA
Zip : 92583-5242
Country : US
Telephone Number : 951-604-9503
Fax Number :
Provider Business Practice Location Address
First Line : 47825 OASIS ST
Second Line :
City : INDIO
State : CA
Zip : 92201-6950
Country : US
Telephone Number : 951-604-9503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2025
Last Update Date : 05/26/2026

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Directions to “ EXAL VEGA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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