Provider Demographics
NPI:1316184161
Name:EGUIA MOREDA, VASCO (MD)
Entity Type:Individual
Prefix:
First Name:VASCO
Middle Name:
Last Name:EGUIA MOREDA
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 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 757
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-910-0909
Mailing Address - Fax:888-588-0319
Practice Address - Street 1:1607 AVE PONCE DE LEON STE GM04
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1803
Practice Address - Country:US
Practice Address - Phone:787-910-0909
Practice Address - Fax:888-588-0319
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20447207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038026304Medicaid
PR038026305Medicaid
PR037939901Medicaid
PR038026303Medicaid
PR038026302Medicaid
PR037891301Medicaid