Provider Demographics
NPI:1942531330
Name:VEGA, CARLOS GABRIEL
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:GABRIEL
Last Name:VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC01 BOX 5488
Mailing Address - Street 2:BA. PESAS
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0000
Mailing Address - Country:US
Mailing Address - Phone:787-871-5504
Mailing Address - Fax:
Practice Address - Street 1:HC01 BOX 5488
Practice Address - Street 2:BA. PESAS
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-0000
Practice Address - Country:US
Practice Address - Phone:787-871-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7626183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician