MEDICARE: ANGELIQUE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1457216640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE VEGA

Provider Business Mailing Address
First Line	:	37 AIRPORT RD
Second Line	:
City	:	FREEDOM
State	:	CA
Zip	:	95019-2616
Country	:	US
Telephone Number	:	831-840-2637
Fax Number	:	831-840-2637

Provider Business Practice Location Address
First Line	:	585 AUTO CENTER DR
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-3764
Country	:	US
Telephone Number	:	831-226-3728
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ ANGELIQUE VEGA ” Practice Location

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