Healthcare Provider Details

I. General information

NPI: 1386891745
Provider Name (Legal Business Name): MRS. VANESSA VANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CALLE JULIO ANDINO
SAN JUAN PR
00924-2252
US

IV. Provider business mailing address

LA VISTA I-5 VIA PANORAMICA
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-0565
  • Fax:
Mailing address:
  • Phone: 787-751-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number6784
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: