Provider Demographics
NPI:1851715494
Name:VEGA RIVERA, CARLOS JAVIER (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JAVIER
Last Name:VEGA RIVERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BLVD MEDIA LUNA
Mailing Address - Street 2:APT 2103
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4918
Mailing Address - Country:US
Mailing Address - Phone:939-403-0093
Mailing Address - Fax:
Practice Address - Street 1:180 BLVD MEDIA LUNA
Practice Address - Street 2:APT 2103
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4918
Practice Address - Country:US
Practice Address - Phone:939-403-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor