Provider Demographics
NPI:1942594601
Name:CABRERA-VEGA, SANTOS (RPH)
Entity Type:Individual
Prefix:
First Name:SANTOS
Middle Name:
Last Name:CABRERA-VEGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CALLE SAN JOSE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1317
Mailing Address - Country:US
Mailing Address - Phone:787-945-7710
Mailing Address - Fax:787-945-7716
Practice Address - Street 1:700 AVE R H TODD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4807
Practice Address - Country:US
Practice Address - Phone:787-945-7710
Practice Address - Fax:787-945-7716
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist