Provider Demographics
NPI:1790202836
Name:PEREZ VEGA, ISABELLA ABIGAIL
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ABIGAIL
Last Name:PEREZ VEGA
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 1:17309 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3703
Mailing Address - Country:US
Mailing Address - Phone:301-742-1914
Mailing Address - Fax:
Practice Address - Street 1:17309 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905
Practice Address - Country:US
Practice Address - Phone:301-742-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program