Provider Demographics
NPI:1619116100
Name:VEGA, MARTIN C (MSC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:C
Last Name:VEGA
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 REAGAN ST
Mailing Address - Street 2:#2
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7117
Mailing Address - Country:US
Mailing Address - Phone:214-545-4525
Mailing Address - Fax:
Practice Address - Street 1:2815 REAGAN ST
Practice Address - Street 2:#2
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-7117
Practice Address - Country:US
Practice Address - Phone:214-545-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling