Provider Demographics
NPI:1437825544
Name:VEGA-RIOS, ESTELA JASMIN
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:JASMIN
Last Name:VEGA-RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5106
Mailing Address - Country:US
Mailing Address - Phone:541-687-2667
Mailing Address - Fax:
Practice Address - Street 1:944 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5106
Practice Address - Country:US
Practice Address - Phone:458-210-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105233175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist