Healthcare Provider Details

I. General information

NPI: 1326041500
Provider Name (Legal Business Name): MANUEL R PRATS VEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE CARAZO
GUAYNABO PR
00969-5639
US

IV. Provider business mailing address

PMB 336, 405 AVE. ESMERALDA SUITE 2
GUAYNABO PR
00969-4457
US

V. Phone/Fax

Practice location:
  • Phone: 787-272-3182
  • Fax: 787-708-2588
Mailing address:
  • Phone: 787-272-0668
  • Fax: 787-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10382
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10382
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: