Provider Demographics
NPI:1073597647
Name:VEGA-VIVAS, WILLIAM A (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:VEGA-VIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:VEGA
Other - Last Name:VEGA- VIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1149
Mailing Address - Country:US
Mailing Address - Phone:787-882-5534
Mailing Address - Fax:787-658-7133
Practice Address - Street 1:CARR.111 KM.0.2 BO. VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9602
Practice Address - Country:US
Practice Address - Phone:787-882-5534
Practice Address - Fax:787-658-7133
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083642Medicare UPIN