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General NPI Number Information
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NPI Number | 1255589024
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Entity Type | Individual
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Provider Name | JUAN A SIERRA VEGA
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Gender | Male
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | CARRETERA 110 KM 20 0 BO CENTRO
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-882-2371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1777
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 787-882-2371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | TC AMB 402
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License Number State | PR
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