Provider Demographics
NPI:1497863187
Name:DE MOYA VEGA, LAURA CATALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CATALINA
Last Name:DE MOYA VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:4 ROBERTS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-820-3000
Mailing Address - Fax:214-820-3022
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:4 ROBERTS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-3000
Practice Address - Fax:214-820-3022
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4028208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183953202Medicaid
TX183953201Medicaid
TX8G0894OtherBCBS
TX8CZ844OtherBCBSTX
TX183953203Medicaid
TX276957YNJCMedicare PIN
TX8CZ844OtherBCBSTX
TX8G8514Medicare PIN
TX183953202Medicaid
TXTXB132526Medicare PIN