Healthcare Provider Details

I. General information

NPI: 1841346541
Provider Name (Legal Business Name): SENEN VEGA SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LIZZIE GRAHAM JR 3 7 MA SECCION
LEVITTOWN TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 52185
TOA BAJA PR
00950-2185
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2948
  • Fax: 787-795-3411
Mailing address:
  • Phone: 787-795-2948
  • Fax: 787-795-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12400
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number12400
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number12400
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: