Provider Demographics
NPI:1891316105
Name:VEGA MORALES, JORGE LUIS
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:VEGA MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14760 SW 66TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2039
Mailing Address - Country:US
Mailing Address - Phone:305-928-3000
Mailing Address - Fax:305-274-5320
Practice Address - Street 1:14760 SW 66TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2039
Practice Address - Country:US
Practice Address - Phone:305-928-3000
Practice Address - Fax:305-274-5320
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-013501208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty