Provider Demographics
NPI:1891316105
Name:VEGA MORALES, JORGE LUIS (PA)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:VEGA MORALES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9495 SW 72ND ST STE B180
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5424
Mailing Address - Country:US
Mailing Address - Phone:305-274-5319
Mailing Address - Fax:305-274-5320
Practice Address - Street 1:9495 SW 72ND ST STE B180
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5424
Practice Address - Country:US
Practice Address - Phone:305-274-5319
Practice Address - Fax:305-274-5320
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR002256-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty