Provider Demographics
NPI:1770815821
Name:VEGA, ANIRAM I (LND)
Entity Type:Individual
Prefix:MISS
First Name:ANIRAM
Middle Name:I
Last Name:VEGA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CALLE REY CARLOS
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3253
Mailing Address - Country:US
Mailing Address - Phone:787-607-8575
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE DEGETAU
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6210
Practice Address - Country:US
Practice Address - Phone:787-798-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR524133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR524OtherDIETIAN LICENCE