Provider Demographics
NPI:1689102782
Name:VEGA, CARMEN ELISA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ELISA
Last Name:VEGA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BLALOCK RD
Mailing Address - Street 2:STE M
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5446
Mailing Address - Country:US
Mailing Address - Phone:713-240-1221
Mailing Address - Fax:
Practice Address - Street 1:1900 BLALOCK RD
Practice Address - Street 2:STE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5446
Practice Address - Country:US
Practice Address - Phone:281-589-8500
Practice Address - Fax:281-589-7165
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063917896OtherPANAMERICANA FAMILY MEDICINE CLINIC
TX17163711Medicaid