Provider Demographics
NPI:1982813861
Name:VEGAS, MARIA ANDREINA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANDREINA
Last Name:VEGAS
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 1:531 GERONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2714
Mailing Address - Country:US
Mailing Address - Phone:305-456-2555
Mailing Address - Fax:
Practice Address - Street 1:8780 SW 92ND ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2457
Practice Address - Country:US
Practice Address - Phone:786-596-7992
Practice Address - Fax:305-595-3088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000744100Medicaid
FLBK700ZMedicare PIN