Provider Demographics
NPI:1619778974
Name:VEGA, JESSICA LYDIA
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYDIA
Last Name:VEGA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 QUINCY ST APT 29
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-1538
Mailing Address - Country:US
Mailing Address - Phone:661-778-9315
Mailing Address - Fax:
Practice Address - Street 1:1626 QUINCY ST APT 29
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-1538
Practice Address - Country:US
Practice Address - Phone:661-778-9315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN749379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse