Basic Information
| Provider Information | |||||||||
| NPI: | 1588629331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEGA | ||||||||
| FirstName: | OSCAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 GATEWAY BLVD W | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799253331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157791716 | ||||||||
| FaxNumber: | 9157791754 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 N OREGON ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155335606 | ||||||||
| FaxNumber: | 9155336691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G3880 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | G3880 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00GH25 | 01 | TX | BCBS OF TEXAS | OTHER | P000GH256 | 05 | TX | MEDICAID | 120219405 | 05 | TX | MEDICAID | 120219407 | 05 | TX | MEDICAID | 8GA416 | 01 | TX | BCBS | OTHER | P01700576 | 01 | TX | RR | OTHER | 120219408 | 05 | TX | MEDICAID |