Provider Demographics
NPI:1013590660
Name:VEGA, JESSICA (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W US HIGHWAY 77 STE C
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4317
Mailing Address - Country:US
Mailing Address - Phone:956-361-4558
Mailing Address - Fax:956-361-4998
Practice Address - Street 1:850 W US HIGHWAY 77 STE C
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4317
Practice Address - Country:US
Practice Address - Phone:956-361-4558
Practice Address - Fax:956-361-4998
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant