MEDICARE: MARIBEL VEGA RIOS

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	332B00000X	Durable Medical Equipment & Medical Supplies		PR
2	3336C0003X	Community/Retail Pharmacy	09-F-1823	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4017869	OTHER	PR	NABP

General Provider Information

NPI Number	:	1245253616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIBEL VEGA RIOS

Provider Business Mailing Address
First Line	:	COND GARDEN CENTER #1 2
Second Line	:	UNIVERSITY GARDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4853
Country	:	US
Telephone Number	:	787-763-1059
Fax Number	:	787-763-1074

Provider Business Practice Location Address
First Line	:	COND GARDEN CEN #1 2
Second Line	:	UNIVERSITY GARDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4853
Country	:	US
Telephone Number	:	787-763-1059
Fax Number	:	787-763-1074

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MARIBEL VEGA RIOS
Credential	:	RPH
Telephone Number	:	787-763-1059

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/03/2008

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Directions to “MARIBEL VEGA RIOS ” Practice Location

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