Provider Demographics
NPI:1639317035
Name:VEGA, KATHERINE EUNICE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:EUNICE
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:ANA MARIA STREET
Mailing Address - Street 2:# 5
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2808
Mailing Address - Country:US
Mailing Address - Phone:787-262-8519
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 KM 6.5 INTERIO BARRIO PUENTE
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-262-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17443208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice