Provider Demographics
NPI:1740949544
Name:VEGA, YANCEY
Entity type:Individual
Prefix:
First Name:YANCEY
Middle Name:
Last Name:VEGA
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 1:555 CALLE YUNES K8
Mailing Address - Street 2:URB. PALACIOS DEL RIO 1
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5017
Mailing Address - Country:US
Mailing Address - Phone:787-234-9736
Mailing Address - Fax:
Practice Address - Street 1:555 CALLE YUNES K8
Practice Address - Street 2:URB. PALACIOS DEL RIO 1
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5017
Practice Address - Country:US
Practice Address - Phone:787-234-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR096373163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty