Provider Demographics
NPI:1568030237
Name:ROMAN VEGA, NORMA I (MED)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:I
Last Name:ROMAN VEGA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 BAY CLUB CIR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2631
Mailing Address - Country:US
Mailing Address - Phone:787-436-4669
Mailing Address - Fax:
Practice Address - Street 1:6925 LAKE ELLENOR DR STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4648
Practice Address - Country:US
Practice Address - Phone:407-552-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional