Provider Demographics
NPI:1982990040
Name:EDGARDO VEGA INC.
Entity type:Organization
Organization Name:EDGARDO VEGA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC,SLP
Authorized Official - Phone:787-644-9817
Mailing Address - Street 1:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1419
Mailing Address - Country:US
Mailing Address - Phone:787-644-9817
Mailing Address - Fax:
Practice Address - Street 1:87 AVE INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-644-9817
Practice Address - Fax:787-264-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech