Provider Demographics
NPI:1609675404
Name:VEGA MEDICAL GROUP INC
Entity type:Organization
Organization Name:VEGA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIGHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MKRTOUMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-240-6912
Mailing Address - Street 1:1101 N PACIFIC AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4316
Mailing Address - Country:US
Mailing Address - Phone:747-240-6912
Mailing Address - Fax:747-240-6913
Practice Address - Street 1:1101 N PACIFIC AVE STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4316
Practice Address - Country:US
Practice Address - Phone:747-240-6912
Practice Address - Fax:747-240-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty