Provider Demographics
NPI:1417933102
Name:DE LA VEGA, HUMBERTO H (MD)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:H
Last Name:DE LA VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 W PRICE RD # 602
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8687
Mailing Address - Country:US
Mailing Address - Phone:956-548-6666
Mailing Address - Fax:956-548-6667
Practice Address - Street 1:4365 N EXPRESSWAY # 7783
Practice Address - Street 2:SUITE 800
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4857
Practice Address - Country:US
Practice Address - Phone:956-548-6666
Practice Address - Fax:956-548-6667
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3216Medicare PIN
TXG87777Medicare UPIN