Provider Demographics
NPI:1396966479
Name:VEGA, JUAN J
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:VEGA
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 1:13850 SW 62ND ST
Mailing Address - Street 2:APT. 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2026
Mailing Address - Country:US
Mailing Address - Phone:786-247-2375
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST
Practice Address - Street 2:SUITE 45
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2900
Practice Address - Country:US
Practice Address - Phone:305-207-2689
Practice Address - Fax:305-559-6470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 35504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist