Provider Demographics
NPI:1982607750
Name:VEGA, RICARDO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:RAFAEL
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27699 JEFFERSON AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2696
Mailing Address - Country:US
Mailing Address - Phone:951-225-1116
Mailing Address - Fax:951-225-1103
Practice Address - Street 1:27699 JEFFERSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:951-225-1116
Practice Address - Fax:951-225-1103
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65736207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A657360Medicaid
CAZZZ01366ZMedicare PIN
CAG30470Medicare UPIN