Healthcare Provider Details

I. General information

NPI: 1356989826
Provider Name (Legal Business Name): ELAINE YANIRA MUNIZ-VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE DE DIEGO, AGUADILLA PUEBLO
AGUADILLA PR
00605
US

IV. Provider business mailing address

URB. COLINAS VERDES CALLE 3 D-1
SAN SEBASTIAN PR
00685
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0012
  • Fax: 787-819-0805
Mailing address:
  • Phone: 787-568-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number15324-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15324-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: