Individual
ISMAEL VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 N BROADWAY STE 101, SANTA ANA, CA 92706-2624
(714) 245-6881
Mailing address
2100 N BROADWAY STE 101, SANTA ANA, CA 92706-2624
(714) 245-6881
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41368
CA
Other
Enumeration date
11/05/2021
Last updated
11/05/2021
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