Provider Demographics
NPI:1023139748
Name:VEGA-RODRIGUEZ, MARITZA (MD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:VEGA-RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
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 70344
Mailing Address - Street 2:PMB 358
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-761-4948
Mailing Address - Fax:787-767-3968
Practice Address - Street 1:HOSPITAL INDUSTRIAL-CENTRO MEDICO
Practice Address - Street 2:BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-754-2525
Practice Address - Fax:787-767-3968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR04435DM-4OtherNARCOTICS STATE LICENSE
PR5475OtherSTATE LICENSE
AV 8934956OtherFEDERAL NARCOTICS LICENSE