Provider Demographics
NPI:1457854705
Name:VEGA, JOSHUA JESUS (PA-S2)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JESUS
Last Name:VEGA
Suffix:
Gender:M
Credentials:PA-S2
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:JESUS
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-S2
Mailing Address - Street 1:60 ELDERBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-3264
Mailing Address - Country:US
Mailing Address - Phone:772-359-4373
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:772-359-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty