Provider Demographics
NPI:1730456625
Name:VEGA, LOURDES MATIAS (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MATIAS
Last Name:VEGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 01 BUZON 2634
Mailing Address - Street 2:BARRIO PINALES ABAJO
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-385-2886
Mailing Address - Fax:
Practice Address - Street 1:BARRIO PINALES ABAJO
Practice Address - Street 2:RR 01 BUZON 2634
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-385-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service