| Ivan Horacio Vega, FNP-BC | |
|
151 S Oak Ave Ste 7, San Luis, AZ 85336-0756 | |
| (928) 366-5166 | |
| (928) 366-5165 |
| Full Name | Ivan Horacio Vega |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Family |
| Location | 151 S Oak Ave Ste 7, San Luis, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720742729 | NPI | - | NPPES |
| 105456 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 268101 (Arizona) | Primary |
| 163WE0003X | Registered Nurse - Emergency | RN185788 (Arizona) | Secondary |
| Entity Name | Dash Medical Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043764566 PECOS PAC ID: 6709166119 Enrollment ID: O20161130002259 |
| Mailing Address | Practice Location Address |
|---|---|
| Ivan Horacio Vega, FNP-BC Po Box 617, Somerton, AZ 85350-0617 Ph: (928) 315-7910 | Ivan Horacio Vega, FNP-BC 151 S Oak Ave Ste 7, San Luis, AZ 85336-0756 Ph: (928) 366-5166 |
Taliah Anabell Torres, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1233 N Main St Ste 1a, San Luis, AZ 85336 Phone: 928-550-5514 | |
Ms. Adlene Joseph, FNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1896 E Babbitt Ln, San Luis, AZ 85349 Phone: 928-722-6112 Fax: 928-722-6113 | |
Larry Anthony Morales, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1233 N Main St Ste 1a, San Luis, AZ 85336 Phone: 928-550-5514 Fax: 928-550-5160 | |
Mrs. Leah K Mcnair, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1896 E. Babbit Lane, San Luis, AZ 85349 Phone: 928-627-9222 Fax: 928-627-8315 | |
Diana Lorena Monroy, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1233 N Main St Ste 1a, San Luis, AZ 85336 Phone: 928-550-5514 | |
Hector Israel De La Torre, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1233 N Main St Ste 1a, San Luis, AZ 85336 Phone: 928-550-5514 Fax: 928-722-6113 | |
Richard Nasiru Elelu, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 7125 East Cesar Chavez Boulevard, San Luis, AZ 85349 Phone: 928-627-8871 |