MEDICARE: CARMEN T VEGA ORTIZ

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	207Q00000X	Family Medicine Physician	8925	PR

General Provider Information

NPI Number	:	1164472114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN T VEGA ORTIZ

Provider Business Mailing Address
First Line	:	COND SANTA ANA
Second Line	:	AVE LUIS VIGOREAUX APTO 8E
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2506
Country	:	US
Telephone Number	:	787-236-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND SANTA ANA
Second Line	:	AVE LUIS VIGOREAUX APTO 8E
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2506
Country	:	US
Telephone Number	:	787-236-3693
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/19/2016

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Directions to “ CARMEN T VEGA ORTIZ ” Practice Location

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