Provider Demographics
NPI:1710042049
Name:VEGA, BLANCA
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 5778
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9721
Mailing Address - Country:US
Mailing Address - Phone:787-862-2244
Mailing Address - Fax:787-862-2244
Practice Address - Street 1:CARR. 633 KM. 4.7
Practice Address - Street 2:BO. BARAHONA
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-2244
Practice Address - Fax:787-862-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist