Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC-003058L | PA |
NPI | 1053511709 |
---|---|
Provider Name | Dr. Jimmy Vega |
First Address | Millersville, PA 17551-9749 |
Second Address | Millersville, PA 17551-9749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 20/07/2007 |