Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 278135 | NY |
N | 207VE0102X | Reproductive Endocrinologist | 278135 | NY |
NPI | 1235428129 |
---|---|
Provider Name | Mario Gilberto Vega |
First Address | Bronx, NY 10461-1900 |
Second Address | Bronx, NY 10461-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 17/12/2015 |