Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 14242 | TX |
NPI | 1891337853 |
---|---|
Provider Name | Ellen Christy Vega |
First Address | Arlington, TX 76015-2359 |
Second Address | Arlington, TX 76015-2359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 11/10/2019 |