| D De La Vega MD P a | |
|
11093 Nw 138th St Unit 112 Hialeah Gardens FL 33018-1190 | |
| (305) 552-0303 | |
| (305) 554-0709 |
| Full Name | D De La Vega MD P a |
|---|---|
| Speciality | Internal Medicine |
| Location | 11093 Nw 138th St Unit 112, Hialeah Gardens, Florida |
| Authorized Official Name and Position | Dagoberto De La Vega (PRESIDENT) |
| Authorized Official Contact | 3052989100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D De La Vega MD P a 11093 Nw 138th St Unit 112 Hialeah Gardens FL 33018-1190 Ph: (305) 552-0303 | D De La Vega MD P a 11093 Nw 138th St Unit 112 Hialeah Gardens FL 33018-1190 Ph: (305) 552-0303 |
| NPI Number | 1063464527 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 02/19/2020 |
| Certification Date | 02/19/2020 |
| Medicare PECOS PAC ID | 5991750135 |
|---|---|
| Medicare Enrollment ID | O20050321000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063464527 | NPI | - | NPPES |
| 377494501 | Medicaid | FL | |
| 26980 | Other | FL | BCBS PROVIDER# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME67856 (Florida) | Primary |
| Provider Name | Dagoberto De La Vega |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114979671 PECOS PAC ID: 8527013762 Enrollment ID: I20050324000042 |
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