Provider Demographics
NPI:1578988630
Name:DRA. NINA M. VEGA C.S.P
Entity Type:Organization
Organization Name:DRA. NINA M. VEGA C.S.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-210-4368
Mailing Address - Street 1:305B TORRE SAN CRISTOBAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2849
Mailing Address - Country:US
Mailing Address - Phone:787-848-7646
Mailing Address - Fax:
Practice Address - Street 1:305B TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2849
Practice Address - Country:US
Practice Address - Phone:787-848-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18207261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)