Provider Demographics
NPI:1174696041
Name:VAGO, ALEXANDER LOUIS (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:LOUIS
Last Name:VAGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4155 MOORPARK AVE
Mailing Address - Street 2:16
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-248-9222
Mailing Address - Fax:408-248-9222
Practice Address - Street 1:4155 MOORPARK AVE
Practice Address - Street 2:16
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1714
Practice Address - Country:US
Practice Address - Phone:408-248-9222
Practice Address - Fax:408-248-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000E12220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E12220Medicare UPIN