Provider Demographics
NPI:1457748386
Name:VEGA REYES, CHRISTIAN SAUL
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:SAUL
Last Name:VEGA REYES
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 1:17 CALLE PADILLA INT
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1454
Mailing Address - Country:US
Mailing Address - Phone:787-425-9779
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE PADILLA INT
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1454
Practice Address - Country:US
Practice Address - Phone:787-425-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice