Provider Demographics
NPI:1790663508
Name:VEGA, VICTORIA (RPH)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ABEITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 TRIBAL ROAD 6
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-8135
Mailing Address - Country:US
Mailing Address - Phone:505-710-4601
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 160
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-0160
Practice Address - Country:US
Practice Address - Phone:505-368-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3171777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist