Provider Demographics
NPI:1336260660
Name:VEGA ROLON, VILMA G (MD)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:G
Last Name:VEGA ROLON
Suffix:
Gender:F
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:PO BOX 1824
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1824
Mailing Address - Country:US
Mailing Address - Phone:787-714-0044
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3335
Practice Address - Country:US
Practice Address - Phone:787-714-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089802Medicare ID - Type Unspecified