Provider Demographics
NPI:1003835638
Name:VEGA HERNANDEZ, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:VEGA HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MARGINAL LAGO ALTO STE 207
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3909
Mailing Address - Country:US
Mailing Address - Phone:787-752-7184
Mailing Address - Fax:
Practice Address - Street 1:PLAZA SAN MIGUEL STE. 207
Practice Address - Street 2:CARR 181 BO. LAS CUEVAS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-752-7184
Practice Address - Fax:787-752-7184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-3676Medicare ID - Type Unspecified