Individual
EXAL VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
47825 OASIS ST, INDIO, CA 92201-6950
(951) 604-9503
Mailing address
1364 KATRINA LN, SAN JACINTO, CA 92583-5242
(951) 604-9503
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Enumeration date
10/06/2025
Last updated
10/24/2025
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