Active NPI
Jesus Ernesto De la Vega Jr.
- Pharmacist
- San Diego, CA
National Provider Identifier
1659016657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 86113
- Practice address
- 13255 Black Mountain Rd
San Diego, CA 92129-2658 - Phone
- (858) 484-7241
- NPI assigned
- May 3, 2022
- Last updated
- May 3, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 86113 | CA | Primary |
Addresses
Primary practice location
13255 Black Mountain Rd
San Diego, CA 92129-2658
Mailing address
5140 Baltimore Dr Apt 144
Address Line 2
La Mesa, CA 91942
Phone (760) 457-5094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86113 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vons Companies Inc | Past | Accepting new patients | |
| Vons Companies Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Vons Pharmacy #0286
- Community/Retail Pharmacy
- Santa Monica, CA
- NPI 1720879919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651536000000",
"number": "1659016657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5140 BALTIMORE DR APT 144",
"address_2": "ADDRESS LINE 2",
"city": "LA MESA",
"state": "CA",
"postal_code": "91942",
"telephone_number": "760-457-5094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13255 BLACK MOUNTAIN RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921292658",
"telephone_number": "858-484-7241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA VEGA",
"first_name": "JESUS",
"middle_name": "ERNESTO",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-03",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "86113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.