Individual
BERTHA ALISIA VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
359 1/2 N CHICAGO ST, LOS ANGELES, CA 90033-1826
(323) 742-2222
Mailing address
359 1/2 N CHICAGO ST, LOS ANGELES, CA 90033-1826
(323) 742-2222
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171M00000X
171M00000X
CA
Enumeration date
08/10/2016
Last updated
08/10/2016
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