1689102782 NPI number — CARMEN ELISA VEGA APRN, FNP-BC

Table of content: CARMEN ELISA VEGA APRN, FNP-BC (NPI 1689102782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689102782 NPI number — CARMEN ELISA VEGA APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEGA
Provider First Name:
CARMEN
Provider Middle Name:
ELISA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689102782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 BLALOCK RD
Provider Second Line Business Mailing Address:
STE M
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77080-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-240-1221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 BLALOCK RD
Provider Second Line Business Practice Location Address:
STE M
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77080-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-589-8500
Provider Business Practice Location Address Fax Number:
281-589-7165
Provider Enumeration Date:
06/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  AP134072 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063917896 . This is a "PANAMERICANA FAMILY MEDICINE CLINIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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