Provider Demographics
NPI:1124383716
Name:CANCIO VEGA, CARIDAD MAYTE (MD)
Entity type:Individual
Prefix:
First Name:CARIDAD
Middle Name:MAYTE
Last Name:CANCIO VEGA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14420 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6338
Mailing Address - Country:US
Mailing Address - Phone:059-686-5473
Mailing Address - Fax:056-318-0303
Practice Address - Street 1:1422 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3700
Practice Address - Country:US
Practice Address - Phone:305-631-8080
Practice Address - Fax:305-631-8030
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123483207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015089100Medicaid