Provider Demographics
NPI:1245686534
Name:VEGA, BENJAMIN ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALEJANDRO
Last Name: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:HACIENDA CONSTANCIA CALLE VISTAMONTE #787
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-692-7604
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2105
Practice Address - Country:US
Practice Address - Phone:787-692-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice