Provider Demographics
NPI:1780667550
Name:VEGA EMMANUELLI, JOSE M SR (MD)
Entity Type:Individual
Prefix:MRS
First Name:JOSE
Middle Name:M
Last Name:VEGA EMMANUELLI
Suffix:SR
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:PO BOX 8457
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-852-5753
Mailing Address - Fax:787-285-4332
Practice Address - Street 1:CALLE DUFRESNE 9 E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-5753
Practice Address - Fax:787-285-4332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5587207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79437Medicare UPIN
25229Medicare ID - Type Unspecified