Provider Demographics
NPI:1669403358
Name:VEGA, PAULA XIOMARA (PRECIDENTE)
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:XIOMARA
Last Name:VEGA
Suffix:
Gender:F
Credentials:PRECIDENTE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8264 NW SOUTH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7451
Mailing Address - Country:US
Mailing Address - Phone:305-885-0740
Mailing Address - Fax:305-332-5459
Practice Address - Street 1:8264 NW SOUTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7451
Practice Address - Country:US
Practice Address - Phone:305-885-0740
Practice Address - Fax:305-332-5459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
FL04548332BX2000X
FLORF 148335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9129OtherBLUE CROSS BLUE SHIELD
FLR9129OtherBLUE CROSS BLUE SHIELD