Provider Demographics
NPI:1366595662
Name:VEGA, FERNANDO DOMINGO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:DOMINGO
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9730 3RD AVE NE STE 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2023
Mailing Address - Country:US
Mailing Address - Phone:206-522-5646
Mailing Address - Fax:206-522-5054
Practice Address - Street 1:9730 3RD AVE NE STE 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2023
Practice Address - Country:US
Practice Address - Phone:206-522-5646
Practice Address - Fax:206-522-5054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD0018929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
911160406OtherEIN