Provider Demographics
NPI:1710445762
Name:BRHELY, VEGA (LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:VEGA
Middle Name:
Last Name:BRHELY
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 ELK LN
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8210
Mailing Address - Country:US
Mailing Address - Phone:970-922-8708
Mailing Address - Fax:
Practice Address - Street 1:1460 E VALLEY RD STE 147
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8414
Practice Address - Country:US
Practice Address - Phone:970-922-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002131171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACU.0002131OtherACUPUNCTURE LICENSE