De La Vega, Mara

De La Vega, Mara is an individual health care provider with primary practice located at 1307 S. International Parkway Suite 2091, Lake Mary FL 32806-2916. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. De La Vega, Mara can be contacted via phone (407) 771-0404.

Contact Information

Primary practice address
1307 S. International Parkway Suite 2091 Lake Mary FL 32806-2916
Fax: (407) 771-0405
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME73219 Florida

Profile Details

NPI number 1750335147
LBN Legal business name De La Vega, Mara
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 20th, 2006
Last updated Dec 8th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750335147 NPPES
Other 080140852 RAILROAD MEDICARE
Other 47060 RAILROAD MEDICARE

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