Provider Demographics
NPI:1699854273
Name:VEGA, LUIS EDUARDO JR (PHD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:EDUARDO
Last Name:VEGA
Suffix:JR
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N ECKHOFF ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1008
Mailing Address - Country:US
Mailing Address - Phone:562-760-0033
Mailing Address - Fax:
Practice Address - Street 1:800 N ECKHOFF ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1008
Practice Address - Country:US
Practice Address - Phone:562-760-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical