Provider Demographics
NPI:1558516344
Name:DE LA VEGA, MICHAEL J (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DE LA VEGA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1283 RODALYN DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-6122
Mailing Address - Country:US
Mailing Address - Phone:910-551-8151
Mailing Address - Fax:
Practice Address - Street 1:2241 NW MILITARY HWY STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4927
Practice Address - Country:US
Practice Address - Phone:210-907-8346
Practice Address - Fax:210-906-8907
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2023-10-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical