Provider Demographics
NPI:1215040027
Name:PEREZ VEGA, GLADYS (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:PEREZ VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:PEREZ
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3569
Mailing Address - Street 2:BAYAMON GARDENS STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958
Mailing Address - Country:US
Mailing Address - Phone:787-740-3558
Mailing Address - Fax:787-787-8133
Practice Address - Street 1:CONDOMINIO LAS TORRES SUR CALLE ISLETA
Practice Address - Street 2:SUITE 3A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-3569
Practice Address - Country:US
Practice Address - Phone:787-740-3558
Practice Address - Fax:787-787-8133
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26435OtherSSS
PR26435Medicare ID - Type Unspecified
D32940Medicare UPIN