Provider Demographics
NPI:1154068310
Name:VEGA, LESLIE YOMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:YOMARIE
Last Name: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 1:4 AVE LAGUNA APT 5D
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6570
Mailing Address - Country:US
Mailing Address - Phone:787-949-1877
Mailing Address - Fax:
Practice Address - Street 1:1105 AVE FD ROOSEVELT STE 5
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2900
Practice Address - Country:US
Practice Address - Phone:787-909-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice