Provider Demographics
NPI:1326138132
Name:AGUAYO VICENTE, BRENDA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:AGUAYO VICENTE
Suffix:
Gender:F
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:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1097
Mailing Address - Country:US
Mailing Address - Phone:787-855-0586
Mailing Address - Fax:787-855-0586
Practice Address - Street 1:29 B CALLE RAMON E. BETANCES
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4465
Practice Address - Country:US
Practice Address - Phone:787-855-0586
Practice Address - Fax:787-855-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14441208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21656Medicare ID - Type Unspecified