Active NPI
Juan Diego Vega Gonzales-Portillo, MD
- Neurology Physician
- Tucson, AZ
National Provider Identifier
1154165835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- R80929
- Practice address
- 1501 N Campbell Ave
Tucson, AZ 85724-0001 - Phone
- (520) 626-1376
- NPI assigned
- Jun 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | R80929 | AZ | Primary |
Addresses
Primary practice location
1501 N Campbell Ave
Tucson, AZ 85724-0001
Mailing address
4521 N Via Entrada Apt 192
Tucson, AZ 85718-7612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240814002447 | AZ | Order and Referring Only - Neurology | 3476091091 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R80929 | AZ | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718755200000",
"number": "1154165835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4521 N VIA ENTRADA APT 192",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857187612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 N CAMPBELL AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857240001",
"telephone_number": "520-626-1376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VEGA GONZALES-PORTILLO",
"first_name": "JUAN DIEGO",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-19",
"last_updated": "2024-06-19",
"certification_date": "2024-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "AZ",
"license": "R80929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.