Provider Demographics
NPI:1497972186
Name:VADI, NITZA NOEMI (MD)
Entity Type:Individual
Prefix:
First Name:NITZA
Middle Name:NOEMI
Last Name:VADI
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:PO BOX 4960
Mailing Address - Street 2:PMB 295
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4960
Mailing Address - Country:US
Mailing Address - Phone:787-615-4611
Mailing Address - Fax:787-703-2299
Practice Address - Street 1:CARR 183 U9
Practice Address - Street 2:URB JOSE MERCADO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-615-4611
Practice Address - Fax:787-703-2299
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027767Medicare ID - Type Unspecified
PRD08436Medicare UPIN