Provider Demographics
NPI:1518405372
Name:VEGA, MARIAISELA
Entity Type:Individual
Prefix:
First Name:MARIAISELA
Middle Name:
Last Name:VEGA
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 1:35918 WCR 55
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-9605
Mailing Address - Country:US
Mailing Address - Phone:970-658-7232
Mailing Address - Fax:
Practice Address - Street 1:35918 WCR 55
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-9605
Practice Address - Country:US
Practice Address - Phone:970-658-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician