Provider Demographics
NPI:1366030595
Name:ABRAHAM VEGA, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ABRAHAM VEGA
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:HC 5 BOX 45503
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9642
Mailing Address - Country:US
Mailing Address - Phone:787-451-0971
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTA ROSA #1
Practice Address - Street 2:SAN JUAN GARDEN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4850
Practice Address - Country:US
Practice Address - Phone:787-766-0075
Practice Address - Fax:787-759-8411
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR002063-PA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice