Provider Demographics
NPI:1891770129
Name:YEJO VEGA, NELIA (MD)
Entity Type:Individual
Prefix:
First Name:NELIA
Middle Name:
Last Name:YEJO VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NELIA
Other - Middle Name:
Other - Last Name:YEJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785
Mailing Address - Country:US
Mailing Address - Phone:787-866-1212
Mailing Address - Fax:787-866-3322
Practice Address - Street 1:CALLE 3 NUM 80 SUR
Practice Address - Street 2:SOUTHERN MEDICAL PLAZA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-866-1212
Practice Address - Fax:787-866-3322
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14509208D00000X
PR13389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081479CMedicare PIN
H80179Medicare UPIN
PRH80179Medicare UPIN