Provider Information for 1588094973
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NIXALYS VEGA
Sex: Female
NPI: 1588094973
Last Updated: 2018-11-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1588094973 | ||||||||
| Enumeration Date | 2013-11-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4500 W MIDWAY RD FT PIERCE, FL 34981-0000 United States Phone: 772-468-5600 | Fax: | ||||||||
| Primary Practice Address | 4500 W MIDWAY RD FT PIERCE, FL 34981 United States Phone: 772-468-5600 | Fax: | ||||||||
| Secondary Practice Address(es) | 6646 NW AGNON CT | ||||||||
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