Provider Demographics
NPI:1376337618
Name:VEGA, STEPHANIE MALENY (CHW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MALENY
Last Name:VEGA
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E 3RD ST UNIT 4402
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4271
Mailing Address - Country:US
Mailing Address - Phone:512-757-9975
Mailing Address - Fax:
Practice Address - Street 1:1600 E 3RD ST UNIT 4402
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4271
Practice Address - Country:US
Practice Address - Phone:512-757-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18332172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker