Provider Demographics
NPI:1255518502
Name:VICTOR-VEGA, CASSANDRE S (MD)
Entity type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:S
Last Name:VICTOR-VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604 DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1384
Mailing Address - Fax:585-276-0122
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604 DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1384
Practice Address - Fax:585-276-0122
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT191379390200000X
NY261584-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program