Provider Demographics
NPI:1881629517
Name:VEGA-TORRES, RAFAEL ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANGEL
Last Name:VEGA-TORRES
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 1:103 PLAZA NUEVE
Mailing Address - Street 2:GRAN VISTA 2
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5056
Mailing Address - Country:US
Mailing Address - Phone:787-630-7217
Mailing Address - Fax:
Practice Address - Street 1:CASIA STREET # 10
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10547207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR69595OtherPROVIDER # FOR CRUZ AZUL,
PR8-2980OtherPROVIDER NUMBER SSS
PR8-2980Medicare PIN
PR8-2980OtherPROVIDER NUMBER SSS