Healthcare Provider Details

I. General information

NPI: 1609942093
Provider Name (Legal Business Name): AIXA E VEGA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 490 KM 3.0 HM 0.5
HATILLO PR
00659-1218
US

IV. Provider business mailing address

PO BOX 1218
HATILLO PR
00659-1218
US

V. Phone/Fax

Practice location:
  • Phone: 787-820-5508
  • Fax: 787-820-5508
Mailing address:
  • Phone: 787-820-5508
  • Fax: 787-820-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3390
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: