Provider Demographics
NPI:1598033961
Name:JOSE VEGA MD PA
Entity Type:Organization
Organization Name:JOSE VEGA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-348-4260
Mailing Address - Street 1:11200 SW 8TH ST
Mailing Address - Street 2:AHC 2 693
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-2516
Mailing Address - Country:US
Mailing Address - Phone:305-348-4260
Mailing Address - Fax:305-348-4430
Practice Address - Street 1:885 SW 109 AVE
Practice Address - Street 2:ROOM 131
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-4260
Practice Address - Fax:305-348-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty