Provider Demographics
NPI:1740205715
Name:VEGA, MICHAEL ROBLES (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBLES
Last Name:VEGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1417 W BEVERLY BLVD
Mailing Address - Street 2:104
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4123
Mailing Address - Country:US
Mailing Address - Phone:323-721-6026
Mailing Address - Fax:323-887-1891
Practice Address - Street 1:1417 W BEVERLY BLVD
Practice Address - Street 2:104
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4123
Practice Address - Country:US
Practice Address - Phone:323-721-6026
Practice Address - Fax:323-887-1891
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2960213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538175997OtherMEDICARE GROUP NPI
CA1101320Medicaid
CAGRE000310Medicaid
CAWE2960FOtherMEDICARE PTAN
CA480003204OtherRAILROAD
CA480009960OtherRAILROAD
CAGRE000311Medicaid
CA1285640649OtherMEDICARE GROUP NPI
WE2960EOtherMEDICARE PTAN
CADA3847OtherRAILROAD
CA1538175997OtherMEDICARE GROUP NPI
CAGRE000310Medicaid
CA0955160001Medicare NSC
CADA3847OtherRAILROAD