Healthcare Provider Details

I. General information

NPI: 1487655486
Provider Name (Legal Business Name): VEGA BAJA MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. BRASILIA MARGINAL #2 ESQ. CALLE 2 D-10 SUITE #3
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1327
VEGA BAJA PR
00694-1327
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-7202
  • Fax: 787-807-6721
Mailing address:
  • Phone: 787-855-7202
  • Fax: 787-807-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number05-P-1381
License Number StatePR

VIII. Authorized Official

Name: MS. DORIS D HERNANDEZ
Title or Position: PRESIDENT
Credential: RN BSN
Phone: 787-855-7202