Provider Demographics
NPI:1609606763
Name:VEGA, SOFIA YVELISSE (DS4)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:YVELISSE
Last Name:VEGA
Suffix:
Gender:F
Credentials:DS4
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CALLE ALCALA APT 701
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3918
Mailing Address - Country:US
Mailing Address - Phone:787-433-3998
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE ALCALA APT 701
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3918
Practice Address - Country:US
Practice Address - Phone:787-433-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program