Provider Demographics
NPI:1629682364
Name:VEGA GONZALEZ, BERBELYZE NOMAR (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:BERBELYZE
Middle Name:NOMAR
Last Name:VEGA GONZALEZ
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 CALLE CUBITA
Mailing Address - Street 2:LOS FRAILES INDUSTRIAL PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-787-7733
Mailing Address - Fax:
Practice Address - Street 1:128 CALLE LUNA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1705
Practice Address - Country:US
Practice Address - Phone:787-791-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist