Provider Demographics
NPI:1962690388
Name:VEGA, JANELLE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:MARIE
Last Name:VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:305-665-6166
Mailing Address - Fax:
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 314
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-665-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology