MEDICARE: IDALYS VEGA RIVERA

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	183500000X	Pharmacist	008241	PR

General Provider Information

NPI Number	:	1518756857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDALYS VEGA RIVERA

Provider Business Mailing Address
First Line	:	720 CARR 140 APT 101
Second Line	:
City	:	BARCELONETA
State	:	PR
Zip	:	00617-3149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLAZA LAS VEGAS
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00693-5242
Country	:	US
Telephone Number	:	787-858-5008
Fax Number	:

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

Provider Enumeration Date	:	05/02/2025
Last Update Date	:	05/02/2025

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Directions to “ IDALYS VEGA RIVERA ” Practice Location

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