MEDICARE: EDISSON 'XAVIER' VEGA-CORDOVA 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
1	207Y00000X	Otolaryngology Physician	125-053608	IL
2	207Y00000X	Otolaryngology Physician	45642	AZ
3	207Y00000X	Otolaryngology Physician	ME134284	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1750574190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDISSON 'XAVIER' VEGA-CORDOVA M.D.

Provider Business Mailing Address
First Line	:	15280 NW 79TH CT STE 200
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5873
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	786-907-4485

Provider Business Practice Location Address
First Line	:	7100 W 20TH AVE STE 608
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1824
Country	:	US
Telephone Number	:	305-557-4016
Fax Number	:	305-828-0670

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

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	12/19/2022

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Directions to “ EDISSON 'XAVIER' VEGA-CORDOVA M.D.” Practice Location

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