Provider Demographics
NPI:1669183232
Name:OSORIO VEGA, JOSE ESTEBAN
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ESTEBAN
Last Name:OSORIO 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 1:1341 SW 124TH CT APT A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2344
Mailing Address - Country:US
Mailing Address - Phone:786-443-6431
Mailing Address - Fax:
Practice Address - Street 1:1341 SW 124TH CT APT A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2344
Practice Address - Country:US
Practice Address - Phone:786-443-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner