Provider Demographics
NPI:1649391707
Name:MALDONADO VEGA, MIRNA (MD)
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:MALDONADO 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:RR 2 BOX 7066
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-299-1067
Mailing Address - Fax:787-294-3622
Practice Address - Street 1:RR 2 BOX 7066
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-299-1067
Practice Address - Fax:787-294-3622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15393207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism