Healthcare Provider Details

I. General information

NPI: 1982990040
Provider Name (Legal Business Name): EDGARDO VEGA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 AVE INTERAMERICANA
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 1419
SAN GERMAN PR
00683-1419
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-9817
  • Fax: 787-264-0667
Mailing address:
  • Phone: 787-644-9817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDGARDO VEGA RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.,C.C.C.,S.L.P
Phone: 787-644-9817