Provider Demographics
NPI:1043842081
Name:VEGA MONTES, CARLOS XAVIER
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:XAVIER
Last Name:VEGA MONTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 CENTER ST. APARTMENT 10
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052
Mailing Address - Country:US
Mailing Address - Phone:787-901-1036
Mailing Address - Fax:
Practice Address - Street 1:60 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5737
Practice Address - Country:US
Practice Address - Phone:787-901-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program