Provider Demographics
NPI:1851812556
Name:DE VARONA VEGA, OSWALDO (MD)
Entity Type:Individual
Prefix:
First Name:OSWALDO
Middle Name:
Last Name:DE VARONA VEGA
Suffix:
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:CALLE 8 LOT 49
Mailing Address - Street 2:CONDOMINIO CHALETS DE CAPARRA APT 2A6
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-637-2517
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine