Provider Demographics
NPI:1285856617
Name:VEGA-MUNIZ, MARISOL (RNM)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:VEGA-MUNIZ
Suffix:
Gender:F
Credentials:RNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-0020
Mailing Address - Country:US
Mailing Address - Phone:787-221-1708
Mailing Address - Fax:
Practice Address - Street 1:911 PASEO RAMON RIVERA
Practice Address - Street 2:URB EL COQUI
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670-2913
Practice Address - Country:US
Practice Address - Phone:787-221-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR968367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife