Provider Demographics
NPI:1710693106
Name:VEGA ROMAN, ROCIO KHRISTAL
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:KHRISTAL
Last Name:VEGA ROMAN
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:EH28 CALLE JOSE GAUTIER BENITEZ
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-2729
Mailing Address - Country:US
Mailing Address - Phone:787-585-6208
Mailing Address - Fax:
Practice Address - Street 1:EH28 CALLE JOSE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2729
Practice Address - Country:US
Practice Address - Phone:787-585-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program