Provider Demographics
NPI:1528942711
Name:VEGA, PALOMA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-2656
Mailing Address - Country:US
Mailing Address - Phone:706-843-7439
Mailing Address - Fax:
Practice Address - Street 1:112 BANKS RD STE 1
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-6300
Practice Address - Country:US
Practice Address - Phone:706-677-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD007785133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered