Provider Demographics
NPI:1275547531
Name:VENEGAS, VICTOR J (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:J
Other - Last Name:VENEGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:MOROVIS
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0389
Mailing Address - Country:US
Mailing Address - Phone:787-369-5533
Mailing Address - Fax:
Practice Address - Street 1:PRINCIPAL 54 #24
Practice Address - Street 2:MOROVIS
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0389
Practice Address - Country:US
Practice Address - Phone:787-369-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87965OtherTRIPLE C
PR993777OtherMMM
PRPE3177OtherPALIC
PR1112627OtherACAA
PR8784OtherINTERNATIONAL MEDICALCARD
PR060022OtherFIRST PLUS
PR060022OtherCRUZ AZUL
PR999124OtherPREFERRED MEDICARE CHOISE
PR999124OtherPREFERRED MEDICARE CHOISE
PR8784OtherINTERNATIONAL MEDICALCARD