Provider Demographics
NPI:1386124485
Name:VEGA MALDONADO, JESUS (02549 MSN)
Entity type:Individual
Prefix:PROF
First Name:JESUS
Middle Name:
Last Name:VEGA MALDONADO
Suffix:
Gender:M
Credentials:02549 MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO BELGICA CALLE CAMPOS #2210
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-627-6297
Mailing Address - Fax:
Practice Address - Street 1:CONSOLIDATED MALL B5
Practice Address - Street 2:AVE. GAUTIER BENITEZ 202
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2549163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2549OtherNURSE