Healthcare Provider Details

I. General information

NPI: 1588753685
Provider Name (Legal Business Name): ZAHIRA V VEGA BONILLA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SAN MIGUEL NO 42
GUANICA PR
00653-1048
US

IV. Provider business mailing address

PO BOX 1048
GUANICA PR
00653-1048
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-2350
  • Fax: 787-821-2350
Mailing address:
  • Phone: 787-821-2350
  • Fax: 787-821-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number406
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: