Provider Demographics
NPI:1386436483
Name:VEGA-COLON, FATIMA GABRIELA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:GABRIELA
Last Name:VEGA-COLON
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 1:6401 REDINGTON DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9020
Mailing Address - Country:US
Mailing Address - Phone:616-666-5817
Mailing Address - Fax:
Practice Address - Street 1:2060 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3029
Practice Address - Country:US
Practice Address - Phone:616-475-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker