Healthcare Provider Details

I. General information

NPI: 1285267609
Provider Name (Legal Business Name): W V P MEDICAL SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. JUAN MARTIN KM 97.3 CALLE 3
YABUCOA PR
00767
US

IV. Provider business mailing address

CIUDAD JARDIN URB LOS SUENOS 33 CALLE FANTASIA
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-893-1120
  • Fax: 787-655-4176
Mailing address:
  • Phone: 787-458-2509
  • Fax: 787-655-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILFREDO VEGA PAGAN
Title or Position: GENERAL PRACTICE
Credential: MD
Phone: 787-458-2509