Provider Demographics
NPI:1982859039
Name:VEGA, ESTELA H (RMT)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:H
Last Name:VEGA
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16607 BLANCO RD
Mailing Address - Street 2:SUITE 12105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1913
Mailing Address - Country:US
Mailing Address - Phone:210-213-3463
Mailing Address - Fax:210-438-7023
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:SUITE 12105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:210-213-3463
Practice Address - Fax:210-438-7023
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT034977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist