Provider Demographics
NPI:1093736548
Name:VEGA, CESAR AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18433 ROSCOE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4126
Mailing Address - Country:US
Mailing Address - Phone:818-734-7620
Mailing Address - Fax:818-734-7621
Practice Address - Street 1:184332 ROSCOE BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-734-7620
Practice Address - Fax:818-734-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A767910Medicaid
CAA76791Medicare ID - Type Unspecified
CA0A767910Medicaid