Provider Demographics
NPI:1760733927
Name:VEGA CORSINO, WILLIAM GIBRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GIBRAN
Last Name:VEGA CORSINO
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:ESTANCIAS DE SAN FERNANDO CALLE 6 E-6
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL EPISCOPAL SAN LUCAS METRO
Practice Address - Street 2:CARR 844 KM 0.5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4146
Practice Address - Country:US
Practice Address - Phone:787-761-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19780208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice