Provider Demographics
NPI:1790963775
Name:VEGA VEGA, LIXANA (MD)
Entity Type:Individual
Prefix:
First Name:LIXANA
Middle Name:
Last Name:VEGA 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 1:950 THREADNEEDLE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2925
Mailing Address - Country:US
Mailing Address - Phone:832-699-8342
Mailing Address - Fax:888-974-1574
Practice Address - Street 1:950 THREADNEEDLE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2925
Practice Address - Country:US
Practice Address - Phone:832-699-8342
Practice Address - Fax:888-974-1574
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0511208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB138204Medicare PIN