Provider Demographics
NPI:1336514116
Name:ANGELA PANIAGUA-VEGA MD PC
Entity Type:Organization
Organization Name:ANGELA PANIAGUA-VEGA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANIAGUA-VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-499-7611
Mailing Address - Street 1:3063 E PLACITA SANTA LUCIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-0814
Mailing Address - Country:US
Mailing Address - Phone:520-742-6400
Mailing Address - Fax:520-531-0128
Practice Address - Street 1:3063 E PLACITA SANTA LUCIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-0814
Practice Address - Country:US
Practice Address - Phone:520-742-6400
Practice Address - Fax:520-531-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43541207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty