Provider Demographics
NPI:1962998351
Name:VEGA, JOE STEVEN JR
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:STEVEN
Last Name:VEGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2601
Mailing Address - Country:US
Mailing Address - Phone:510-640-3196
Mailing Address - Fax:
Practice Address - Street 1:3907 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2601
Practice Address - Country:US
Practice Address - Phone:510-640-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty