Provider Demographics
NPI:1215967864
Name:VEGA, ANGEL P (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:P
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-405-3924
Practice Address - Street 1:5611 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3532
Practice Address - Country:US
Practice Address - Phone:813-397-5320
Practice Address - Fax:813-405-3709
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0615498Medicaid
FL0615498Medicaid
FL30699Medicare ID - Type Unspecified