Provider Demographics
NPI:1386640795
Name:VEGA CRUZ, ASTER MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASTER
Middle Name:MANUEL
Last Name:VEGA CRUZ
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:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0171
Mailing Address - Country:US
Mailing Address - Phone:787-264-0709
Mailing Address - Fax:787-264-0709
Practice Address - Street 1:41 CALLE JAVILLA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-0709
Practice Address - Fax:787-264-0709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68389Medicare UPIN