Provider Demographics
NPI:1164290029
Name:VEGA DIAZ, ARELIS
Entity Type:Individual
Prefix:
First Name:ARELIS
Middle Name:
Last Name:VEGA DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CALLE 14 NE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2331
Mailing Address - Country:US
Mailing Address - Phone:787-901-5443
Mailing Address - Fax:
Practice Address - Street 1:1108 CALLE 14 NE APT 4
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2331
Practice Address - Country:US
Practice Address - Phone:787-901-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program