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NPI Code Detail

MEDICARE: EDGARDO JOSE VEGA CRNA

MEDICARE: EDGARDO JOSE VEGA CRNA
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
1367500000XCertified Registered Nurse Anesthetist168576NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430053149OTHERNCRAILROAD-MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598810681
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDGARDO JOSE VEGA CRNA
Provider Business Mailing Address
First Line : PO BOX 535395
Second Line :
City : ATLANTA
State : GA
Zip : 30353-5321
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4420 LAKE BOONE TRL
Second Line :
City : RALEIGH
State : NC
Zip : 27607-7505
Country : US
Telephone Number : 919-784-3034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 04/15/2026

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Directions to “ EDGARDO JOSE VEGA CRNA” Practice Location

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