Provider Demographics
NPI:1841346541
Name:VEGA, SENEN SR (MD)
Entity type:Individual
Prefix:MR
First Name:SENEN
Middle Name:
Last Name:VEGA
Suffix:SR
Gender:M
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 52185
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2185
Mailing Address - Country:US
Mailing Address - Phone:787-795-2948
Mailing Address - Fax:787-795-3411
Practice Address - Street 1:CALLE LIZZIE GRAHAM
Practice Address - Street 2:JR 3 7 MA SECCION
Practice Address - City:LEVITTOWN TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-2948
Practice Address - Fax:787-795-3411
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12400207Q00000X, 207QG0300X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67172Medicare UPIN