Basic Information
| Provider Information | |||||||||
| NPI: | 1255518502 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VICTOR-VEGA | ||||||||
| FirstName: | CASSANDRE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852751384 | ||||||||
| FaxNumber: | 5852760122 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852751384 | ||||||||
| FaxNumber: | 5852760122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT191379 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 261584-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.