Organization
FREDERICK J DE LA VEGA, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK J. DE LA VEGA M.D. (OWNER)
(858) 677-1755
Entity
Organization
Contact information
Practice address
9834 GENESEE AVE, 411, LA JOLLA, CA 92037-1223
(858) 677-1755
(858) 677-1771
Mailing address
23052 ALICIA PKWY, # 619, MISSION VIEJO, CA 92692-1643
(714) 808-9797
(714) 808-9393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A81923
CA
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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