Provider Demographics
NPI:1922751718
Name:SANCHEZ VEGA, GERARDO JOSE
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:JOSE
Last Name:SANCHEZ VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 14, RAMAL 162
Mailing Address - Street 2:KM 0, HM 6
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00735
Mailing Address - Country:US
Mailing Address - Phone:787-358-9506
Mailing Address - Fax:
Practice Address - Street 1:CARR 14, RAMAL 162
Practice Address - Street 2:KM 0, HM 6
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-358-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4846517172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPCTPC-480591OtherGOVERNMENT OF PUERTO RICO, BUREAU OF TRANSPORTATION AND OTHER PUBLIC SERVICES