Provider Demographics
NPI:1710187786
Name:VEGA, GILBERTO (MD, PT)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 MELETO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6513
Mailing Address - Country:US
Mailing Address - Phone:407-453-4541
Mailing Address - Fax:
Practice Address - Street 1:239 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1734
Practice Address - Country:US
Practice Address - Phone:386-427-4868
Practice Address - Fax:386-427-6350
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233352251X0800X
390200000X
FLME152251207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program