Provider Demographics
NPI:1215543277
Name:BASTIAN VEGA, HAROLD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WILLIAM
Last Name:BASTIAN VEGA
Suffix:
Gender:M
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:EL LEGADO GOLF RESORT
Mailing Address - Street 2:APT.424
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-692-0311
Mailing Address - Fax:
Practice Address - Street 1:EL LEGADO GOLF RESORT
Practice Address - Street 2:APT.424
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-692-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice