Provider Demographics
NPI:1417090408
Name:ZAHIRA VEGA BONILLA
Entity Type:Organization
Organization Name:ZAHIRA VEGA BONILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECNOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZAHIRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:6751
Authorized Official - Phone:787-821-2350
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-1048
Mailing Address - Country:US
Mailing Address - Phone:787-821-2350
Mailing Address - Fax:787-821-2350
Practice Address - Street 1:CALLE SAN MIGUEL NO 42
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-1048
Practice Address - Country:US
Practice Address - Phone:787-821-2350
Practice Address - Fax:787-821-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR406291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031514Medicare PIN