Provider Demographics
NPI:1144421546
Name:MOLINA-VEGA, MANUEL ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALBERTO
Last Name:MOLINA-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 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3525 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1965
Practice Address - Country:US
Practice Address - Phone:863-603-6565
Practice Address - Fax:863-904-1961
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1017292086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149237OtherUNIVERSAL HEALTHCARE
FL6201678OtherCIGNA
FL000519200Medicaid
FL48653OtherBCBS OF FL
FL493553OtherWELLCARE PROVIDER #
FLDA5786OtherGROUP MEDICARE RR #
FL1497748743OtherGROUP NPI / LRHSI
FLK3569OtherGROUP MEDICARE #
FLAN414YMedicare PIN