Provider Demographics
NPI:1215290341
Name:VEGA-BURTON, MARIA
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:VEGA-BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EINSTEIN LOOP
Mailing Address - Street 2:APT # 9E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4903
Mailing Address - Country:US
Mailing Address - Phone:718-671-4970
Mailing Address - Fax:718-671-4970
Practice Address - Street 1:140 EINSTEIN LOOP
Practice Address - Street 2:9E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:718-671-4970
Practice Address - Fax:718-671-4970
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092370851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist