Provider Demographics
NPI:1164529608
Name:VEGA, VILMA M (MD)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:M
Last Name:VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8312
Mailing Address - Country:US
Mailing Address - Phone:407-479-2013
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:3135 STATE ROAD 580 STE 1
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4917
Practice Address - Country:US
Practice Address - Phone:727-725-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0068013207RI0200X
FLME0068013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26771OtherBCBS FL
FL378141100Medicaid
FL26771ZMedicare PIN
FL26771OtherBCBS FL