1215040027 NPI number — GLADYS PEREZ VEGA MD

Table of content: GLADYS PEREZ VEGA MD (NPI 1215040027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215040027 NPI number — GLADYS PEREZ VEGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ VEGA
Provider First Name:
GLADYS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VEGA
Provider Other First Name:
GLADYS
Provider Other Middle Name:
PEREZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215040027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3569
Provider Second Line Business Mailing Address:
BAYAMON GARDENS STATION
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-740-3558
Provider Business Mailing Address Fax Number:
787-787-8133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONDOMINIO LAS TORRES SUR CALLE ISLETA
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-3569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-740-3558
Provider Business Practice Location Address Fax Number:
787-787-8133
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  5609 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26435 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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