Provider Demographics
NPI:1144849019
Name:VEGA, OLGA KARINA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:KARINA
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 N HAYDEN RD STE J112
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2484
Mailing Address - Country:US
Mailing Address - Phone:480-687-2370
Mailing Address - Fax:480-687-3844
Practice Address - Street 1:8160 N HAYDEN RD STE J112
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2484
Practice Address - Country:US
Practice Address - Phone:480-687-2370
Practice Address - Fax:480-687-3844
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8171363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty