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General NPI Number Information
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NPI Number | 1982990040
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Entity Type | Organization
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Legal Business Name | EDGARDO VEGA INC.
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 87 AVE INTERAMERICANA
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-644-9817
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Fax | 787-264-0667
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Provider Business Mailing Address
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Address Line | PO BOX 1419
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City | SAN GERMAN
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State | PR
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Zip | 00683-1419
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Country | US
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Telephone | 787-644-9817
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | EDGARDO VEGA RODRIGUEZ
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Credential | M.S.,C.C.C.,S.L.P
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Telephone | 787-644-9817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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