Provider Demographics
NPI:1245384023
Name:VEGA, MARIA AVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:AVA
Last Name:VEGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA AVA BELLA
Other - Middle Name:ANDAYA
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2376 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-533-5947
Mailing Address - Fax:310-533-7190
Practice Address - Street 1:2376 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-533-5947
Practice Address - Fax:310-533-7190
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4505101OtherMEDI CAL