Provider Demographics
NPI:1124599733
Name:VEGA, JONTE MATEO (RN)
Entity Type:Individual
Prefix:
First Name:JONTE
Middle Name:MATEO
Last Name:VEGA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11385 QUARTZ DR APT 84
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2605
Mailing Address - Country:US
Mailing Address - Phone:281-545-7662
Mailing Address - Fax:
Practice Address - Street 1:11385 QUARTZ DR APT 84
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2605
Practice Address - Country:US
Practice Address - Phone:281-545-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95069228163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse