Provider Demographics
NPI:1467441386
Name:VEGA-FELICIANO, EDWIN DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:DAVID
Last Name:VEGA-FELICIANO
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 20930
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0930
Mailing Address - Country:US
Mailing Address - Phone:787-767-0770
Mailing Address - Fax:787-767-0770
Practice Address - Street 1:112 MEDINA CENTER
Practice Address - Street 2:STE 110
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-0930
Practice Address - Country:US
Practice Address - Phone:787-767-0770
Practice Address - Fax:787-767-0770
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3831207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0095359Medicare ID - Type Unspecified
PRC84003Medicare UPIN