Provider Demographics
NPI:1427559525
Name:OLIVERAS VEGA, MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:OLIVERAS 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:I16 CALLE 2
Mailing Address - Street 2:REPARTO UNIVERSIDAD
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-538-1199
Mailing Address - Fax:
Practice Address - Street 1:237 AVE LOS VETERANOS
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2509
Practice Address - Country:US
Practice Address - Phone:787-899-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19855208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice