Provider Demographics
NPI:1114071354
Name:VEGA-HERNANDEZ, FERNANDO LUIS SR (BSPH)
Entity Type:Individual
Prefix:MS
First Name:FERNANDO
Middle Name:LUIS
Last Name:VEGA-HERNANDEZ
Suffix:SR
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4041
Mailing Address - Country:US
Mailing Address - Phone:787-851-1250
Mailing Address - Fax:
Practice Address - Street 1:45 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4041
Practice Address - Country:US
Practice Address - Phone:787-851-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist