Doctor Name: | DR. MARISOL VEGA |
NPI Number: | 1679788012 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 10366 |
Business Practice Address: | Ave.65 Inf. Bo. San Anton Parque Escorial Lote #3 Carolina, PR - 00985 |
Business Phone Number: | 7877576850 |
Business Fax Number: | |
Mailing Address: | Portal De Los Pinos Rr36 Box 19, SAN JUAN |
State: | PR |
Postal Code: | 00926 |
Phone Number: | 7877608932 |
Fax Number: | |
NPI Enumeration Date: | 05/11/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 10366 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |