Healthcare Provider Details

I. General information

NPI: 1659362895
Provider Name (Legal Business Name): DESSIE L VEGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 05/19/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE RUFINO MARTINEZ AX-1 LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 51911
TOA BAJA PR
00950-1911
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-6199
  • Fax: 787-261-3552
Mailing address:
  • Phone: 787-261-6199
  • Fax: 787-261-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10397
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: