Provider Demographics
NPI:1659376564
Name:VEGA MACHAL, HERNAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:E
Last Name:VEGA MACHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAN JORGE - RAMIREZ
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4517
Mailing Address - Country:US
Mailing Address - Phone:787-851-5985
Mailing Address - Fax:787-851-5985
Practice Address - Street 1:35 QUINONES
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4052
Practice Address - Country:US
Practice Address - Phone:787-851-5985
Practice Address - Fax:787-851-5985
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37227Medicare UPIN
PR84638Medicare PIN