MEDICARE: RALPH R 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	207Q00000X	Family Medicine Physician	A42200	CA

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	:	1902900012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH R VEGA

Provider Business Mailing Address
First Line	:	1666 N. MEDICAL CENTER DRIVE
Second Line	:	SUITE 2
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411
Country	:	US
Telephone Number	:	909-880-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 N. MEDICAL CENTER DRIVE
Second Line	:	SUITE 2
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411
Country	:	US
Telephone Number	:	909-880-2491
Fax Number	:	909-880-2495

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	06/30/2015

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Directions to “ RALPH R VEGA ” Practice Location

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