Provider Demographics
NPI:1497801294
Name:VEGA, MARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name: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 1:411 AVE DE DIEGO
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3706
Mailing Address - Country:US
Mailing Address - Phone:787-782-5949
Mailing Address - Fax:787-782-5949
Practice Address - Street 1:411 AVE DE DIEGO
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3706
Practice Address - Country:US
Practice Address - Phone:787-782-5949
Practice Address - Fax:787-782-5949
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9443208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-77442Medicare UPIN
PR81461Medicare ID - Type UnspecifiedMEDICARE