Provider Demographics
NPI:1760711568
Name:VEGA, NATALIE ROSE (IMF 60496)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:ROSE
Last Name:VEGA
Suffix:
Gender:F
Credentials:IMF 60496
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 N TU SU LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8058
Mailing Address - Country:US
Mailing Address - Phone:760-873-6111
Mailing Address - Fax:760-872-8152
Practice Address - Street 1:52 N TU SU LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8058
Practice Address - Country:US
Practice Address - Phone:760-873-6111
Practice Address - Fax:760-872-8152
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist