Mara De la Vega, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME73219 Issued in FL

Practice address

1307 S. International Parkway
Suite 2091
Lake Mary, FL 32806-2916

Phone

(407) 771-0404

Fax

(407) 771-0405

NPI assigned

May 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Florida Inpatient Medicine LLC

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1649228859
  Medicare reassignment NPD
• North Brevard Medical Support, Inc

  • Multi-Specialty Clinic/Center
  • Titusville, FL
  • NPI 1609834886
  Medicare reassignment NPD
• Eternamd

  • Ph.D. Medical Genetics
  • Lake Mary, FL
  • NPI 1508016205
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228694400000",
    "number": "1750335147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 S. INTERNATIONAL PARKWAY",
            "address_2": "SUITE 2091",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "328062916",
            "telephone_number": "407-771-0404",
            "fax_number": "407-771-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 S. INTERNATIONAL PARKWAY",
            "address_2": "SUITE 2091",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "328062916",
            "telephone_number": "407-771-0404",
            "fax_number": "407-771-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA VEGA",
        "first_name": "MARA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2008-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME73219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080140852",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47060",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Day, CRNA
• Dbron Consulting LLC
• Jan Manuel De Camps Antonio, M.D.
• Danielle Brooke De Gaetano
• Jennifer Lynn De la Fuente
• Melissa Bailey De Reyna, PHARM D
• Dean L. Johnston, MD., Inc
• Dean M Edwards DPT Inc
• Cassie Dean, RBT
• Nathan Christopher Deangelis, D.O.

• Family Medicine Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; 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.

Verify at the official NPI Registry.