Provider Demographics
NPI:1730314006
Name:JULIO C. VEGA, M.D. INC
Entity Type:Organization
Organization Name:JULIO C. VEGA, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - CORP. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-850-1872
Mailing Address - Street 1:11100 WARNER AVE.
Mailing Address - Street 2:#302
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-850-1872
Mailing Address - Fax:714-850-1874
Practice Address - Street 1:11100 WARNER AVE.
Practice Address - Street 2:#302
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-850-1872
Practice Address - Fax:714-850-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33429207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33429AMedicare UPIN
CAA33429AMedicare PIN