Provider Demographics
NPI:1790933877
Name:PANIAGUA VEGA, ANGELA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:PANIAGUA VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10425 N ORACLE RD STE 105
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9360
Practice Address - Country:US
Practice Address - Phone:520-544-7644
Practice Address - Fax:520-544-0548
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ564225Medicaid
AZZ141713Medicare PIN