| De La Vega Medical Group Corporation | |
|
12781 World Plaza Ln Bldg 88 Fort Myers FL 33907-7628 | |
| (239) 848-9026 | |
| Not Available |
| Full Name | De La Vega Medical Group Corporation |
|---|---|
| Speciality | General Practice |
| Location | 12781 World Plaza Ln Bldg 88, Fort Myers, Florida |
| Authorized Official Name and Position | Jane Liz De La Vega (ARNP-FNP) |
| Authorized Official Contact | 2398489026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| De La Vega Medical Group Corporation 225 Santa Barbara Blvd Cape Coral FL 33991-2032 Ph: (239) 848-9026 | De La Vega Medical Group Corporation 12781 World Plaza Ln Bldg 88 Fort Myers FL 33907-7628 Ph: (239) 848-9026 |
| NPI Number | 1538870696 |
|---|---|
| Provider Enumeration Date | 12/09/2022 |
| Last Update Date | 01/24/2024 |
| Medicare PECOS PAC ID | 0042685364 |
|---|---|
| Medicare Enrollment ID | O20230418002226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538870696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jane Liz De La Vega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245949973 PECOS PAC ID: 1951776277 Enrollment ID: I20230418002285 |
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