Provider Demographics
NPI:1588753685
Name:VEGA BONILLA, ZAHIRA V (MT)
Entity type:Individual
Prefix:MISS
First Name:ZAHIRA
Middle Name:V
Last Name:VEGA BONILLA
Suffix:
Gender:F
Credentials:MT
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 1048
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-1048
Mailing Address - Country:US
Mailing Address - Phone:787-821-2350
Mailing Address - Fax:787-821-2350
Practice Address - Street 1:CALLE SAN MIGUEL NO 42
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-1048
Practice Address - Country:US
Practice Address - Phone:787-821-2350
Practice Address - Fax:787-821-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR406291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031514Medicare ID - Type Unspecified