Healthcare Provider Details

I. General information

NPI: 1386714251
Provider Name (Legal Business Name): RICARDO VEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CIM II CARR 165 #90 SUITE 303
GUAYNABO PR
00968
US

IV. Provider business mailing address

3011 PLAZA PLAYERA CAMINO DEL MAR
TOA BAJA PR
00949-4368
US

V. Phone/Fax

Practice location:
  • Phone: 787-277-1166
  • Fax: 787-277-1166
Mailing address:
  • Phone: 787-261-5034
  • Fax: 787-795-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number8807
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: