MEDICARE: VEGA BAJA MEDICAL SERVICES INC.

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	05-P-1381	PR

General Provider Information

NPI Number	:	1487655486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGA BAJA MEDICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 1327
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00694-1327
Country	:	US
Telephone Number	:	787-855-7202
Fax Number	:	787-807-6721

Provider Business Practice Location Address
First Line	:	URB. BRASILIA MARGINAL #2
Second Line	:	ESQ. CALLE 2 D-10 SUITE #3
City	:	VEGA BAJA
State	:	PR
Zip	:	00693
Country	:	US
Telephone Number	:	787-855-7202
Fax Number	:	787-807-6721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DORIS D HERNANDEZ
Credential	:	RN BSN
Telephone Number	:	787-855-7202

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/27/2008

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Directions to “VEGA BAJA MEDICAL SERVICES INC. ” Practice Location

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