Provider Demographics
NPI:1124186812
Name:CASTA VEGA, YVONNE O (MD)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:O
Last Name:CASTA VEGA
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:URB CAMINO DEL SUR
Mailing Address - Street 2:346 CALLE FALCON
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2807
Mailing Address - Country:US
Mailing Address - Phone:787-841-9319
Mailing Address - Fax:787-841-9319
Practice Address - Street 1:EDIFICIO CONCORDIA SUITE 501
Practice Address - Street 2:CALLE CONCORDIA 8129
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-841-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7637208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29534Medicaid
7170068OtherHUMANA
PR29534Medicaid
29534Medicare ID - Type Unspecified