Provider Demographics
NPI:1063625259
Name:VEGA, MARIBEL
Entity type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E3 CALLE ACERINA
Mailing Address - Street 2:URBANIZACION RIVIERA DE CUPEY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7406
Mailing Address - Country:US
Mailing Address - Phone:787-748-7542
Mailing Address - Fax:787-748-7542
Practice Address - Street 1:E3 CALLE ACERINA
Practice Address - Street 2:URBANIZACION RIVIERA DE CUPEY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7406
Practice Address - Country:US
Practice Address - Phone:787-748-7542
Practice Address - Fax:787-748-7542
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2923183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2923Medicare UPIN