Provider Demographics
NPI:1841530185
Name:DELA VEGA, RONALDO (NP)
Entity type:Individual
Prefix:
First Name:RONALDO
Middle Name:
Last Name:DELA VEGA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39500 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2211
Mailing Address - Country:US
Mailing Address - Phone:510-252-5868
Mailing Address - Fax:510-456-4390
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2211
Practice Address - Country:US
Practice Address - Phone:510-252-5868
Practice Address - Fax:510-456-4390
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22825363LF0000X
NV001443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily