Provider Demographics
NPI:1700848546
Name:VEGA, ERNESTO JR (ERNESTO VEGA)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:VEGA
Suffix:JR
Gender:M
Credentials:ERNESTO VEGA
Other - Prefix:MR
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:ERNESTO VEGA,ATC
Mailing Address - Street 1:1757 DUFFY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-3065
Mailing Address - Country:US
Mailing Address - Phone:530-354-6533
Mailing Address - Fax:
Practice Address - Street 1:100 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7405
Practice Address - Country:US
Practice Address - Phone:530-354-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer