Healthcare Provider Details

I. General information

NPI: 1871569673
Provider Name (Legal Business Name): JESSICA RODRIGUEZ VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 123 KM 10.6 BO MAGUEYES LOCAL 6
PONCE PR
00728
US

IV. Provider business mailing address

PO BOX 800652
COTO LAUREL PR
00780-0652
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-3400
  • Fax: 787-841-4092
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13926
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: