MEDICARE: MS. MARITZA VEGA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	17590	PR

General Provider Information

NPI Number	:	1093796831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARITZA VEGA RN

Provider Business Mailing Address
First Line	:	PO BOX 810202
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00981-0202
Country	:	US
Telephone Number	:	787-767-7676
Fax Number	:	787-764-9124

Provider Business Practice Location Address
First Line	:	AVENUE 65 INFANTERIA KM 3.4
Second Line	:	BO. SABANA LLANA
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-767-7676
Fax Number	:	787-764-9124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/23/2009

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