Provider Demographics
NPI:1609942093
Name:VEGA RODRIGUEZ, AIXA E
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:E
Last Name:VEGA RODRIGUEZ
Suffix:
Gender:F
Credentials:
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 1218
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1218
Mailing Address - Country:US
Mailing Address - Phone:787-820-5508
Mailing Address - Fax:787-820-5508
Practice Address - Street 1:CARR 490 KM 3.0 HM 0.5
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1218
Practice Address - Country:US
Practice Address - Phone:787-820-5508
Practice Address - Fax:787-820-5508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3390246QM0706X
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030954Medicare PIN