Healthcare Provider Details

I. General information

NPI: 1093796831
Provider Name (Legal Business Name): MARITZA VEGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE 65 INFANTERIA KM 3.4 BO. SABANA LLANA
RIO PIEDRAS PR
00924
US

IV. Provider business mailing address

PO BOX 810202
CAROLINA PR
00981-0202
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7676
  • Fax: 787-764-9124
Mailing address:
  • Phone: 787-767-7676
  • Fax: 787-764-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number17590
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: