Provider Demographics
NPI:1265641765
Name:VEGA, ENRIQUE EVELIO (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:EVELIO
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1925 MIZELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4155
Mailing Address - Country:US
Mailing Address - Phone:407-303-7399
Mailing Address - Fax:407-303-7305
Practice Address - Street 1:1925 MIZELL AVE STE 201
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4155
Practice Address - Country:US
Practice Address - Phone:407-303-7399
Practice Address - Fax:407-303-7305
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-02-18
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Provider Licenses
StateLicense IDTaxonomies
FLME105643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery