Provider Demographics
NPI:1295753457
Name:JUAN A SIERRA VEGA
Entity type:Organization
Organization Name:JUAN A SIERRA VEGA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIERRA VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-448-3153
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1777
Mailing Address - Country:US
Mailing Address - Phone:787-448-3153
Mailing Address - Fax:
Practice Address - Street 1:CARR 110 KM 20.0 BO CENTRO
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-448-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 4023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058193Medicare PIN