Provider Demographics
NPI:1063632198
Name:DRS M VEGA VIDAL Y SANCHEZ ROSSETTI
Entity type:Organization
Organization Name:DRS M VEGA VIDAL Y SANCHEZ ROSSETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-3700
Mailing Address - Street 1:PO BOX 363102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3102
Mailing Address - Country:US
Mailing Address - Phone:787-765-3700
Mailing Address - Fax:
Practice Address - Street 1:382 DOMENECH AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-3102
Practice Address - Country:US
Practice Address - Phone:787-765-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty