Individual
VANESSA LAURA VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7400 SUNRISE BLVD, CITRUS HEIGHTS, CA 95610-3011
(916) 722-2227
(916) 723-0142
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4302
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
20856
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA20856
—
CA
01
—
PA20856 - EFF 6/4/12
MEDI-CAL
CA
Enumeration date
06/15/2010
Last updated
08/23/2012
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