Provider Demographics
NPI:1205411253
Name:VEGA, MARCO A (ATP)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:VEGA
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371140
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-1140
Mailing Address - Country:US
Mailing Address - Phone:915-595-3356
Mailing Address - Fax:
Practice Address - Street 1:9801 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1501
Practice Address - Country:US
Practice Address - Phone:915-595-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A225CA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ATP93740OtherASSISTIVE TECHNOLOGY PROFESSIONAL