Provider Demographics
NPI:1669745063
Name:VEGA, DAINA (LND)
Entity type:Individual
Prefix:
First Name:DAINA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE B 1
Mailing Address - Street 2:REPARTO SOBRINO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-854-3115
Mailing Address - Fax:787-884-5016
Practice Address - Street 1:ATENAS B36 CALLE ELLIOT VEGA
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-664-7772
Practice Address - Fax:787-884-5016
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1358133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist