Provider Demographics
NPI:1992372593
Name:VEGA BARRAZA, ERICK JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:JOSE
Last Name:VEGA BARRAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY AV.
Mailing Address - Street 2:MEDICINE OFFICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-8000
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY AV
Practice Address - Street 2:MEDICINE OFFICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-03-19
Deactivation Date:2023-04-05
Deactivation Code:
Reactivation Date:2024-03-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program