Provider Information for 1639557754
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MARIA VEGA LCSW 112833
Sex: Female
NPI: 1639557754
Last Updated: 2023-09-26
Certification Date: 2023-01-19
Certification Date: 2023-01-19
Details
| Name | Value | ||||||||||||||
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| NPI | 1639557754 | ||||||||||||||
| Enumeration Date | 2015-05-08 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1005 DE HAVEN ST SAN FERNANDO, CA 91340-2130 United States Phone: 818-259-2954 | Fax: | ||||||||||||||
| Primary Practice Address | 14535 SHERMAN CIR VAN NUYS, CA 91405-3087 United States Phone: 818-901-4930 | Fax: | ||||||||||||||
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