Provider Demographics
NPI:1689049397
Name:SANTIAGO VEGA, DANYRA L (MD)
Entity Type:Individual
Prefix:
First Name:DANYRA
Middle Name:L
Last Name:SANTIAGO 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:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1565
Mailing Address - Country:US
Mailing Address - Phone:787-223-6755
Mailing Address - Fax:
Practice Address - Street 1:CARR. 339 KM 3.3
Practice Address - Street 2:BO CAMBALACHE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-223-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19,212208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice