Provider Demographics
NPI:1477015493
Name:VEGA, SAMUEL ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALFONSO
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5050 CRENSHAW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5050 CRENSHAW RD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:832-399-4120
Practice Address - Fax:832-399-4121
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0971207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine