Provider Demographics
NPI:1053817148
Name:VEGA, LOURDES M (RN BSN)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:VEGA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:M
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN
Mailing Address - Street 1:PO BOX 362046
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 877 KM 1.6 CAMINO LAS LOMAS
Practice Address - Street 2:HOSPITAL SAN JUAN CAPESTRANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-760-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse