Provider Demographics
NPI:1629445283
Name:DELA VEGA, RUDY NELSON DELENA JR (RN)
Entity Type:Individual
Prefix:
First Name:RUDY NELSON
Middle Name:DELENA
Last Name:DELA VEGA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SUNSET AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2003
Mailing Address - Country:US
Mailing Address - Phone:916-396-2345
Mailing Address - Fax:
Practice Address - Street 1:333 SUNSET AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2003
Practice Address - Country:US
Practice Address - Phone:916-396-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606485163W00000X, 163WD1100X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal