Provider Demographics
NPI:1790868610
Name:VEGA, PABLO E (DPM)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:E
Last Name:VEGA
Suffix:
Gender:M
Credentials:DPM
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 631
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0631
Mailing Address - Country:US
Mailing Address - Phone:787-883-4977
Mailing Address - Fax:
Practice Address - Street 1:THE GALLERY AT GRAN CARIBE
Practice Address - Street 2:SUITE 205
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48088Medicare ID - Type Unspecified
PRU69476Medicare UPIN