Provider Demographics
NPI:1982776746
Name:SOTOMAYOR-VEGA, LISA MICHELLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:SOTOMAYOR-VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 2502261
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:RI
Mailing Address - Zip Code:00604
Mailing Address - Country:US
Mailing Address - Phone:787-629-9863
Mailing Address - Fax:787-813-1836
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:SUITE 314
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-629-9863
Practice Address - Fax:787-813-1836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15087OtherLICENSE