Basic Information
| Provider Information | |||||||||
| NPI: | 1366030595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM VEGA | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 5 BOX 45503 | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006939642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874510971 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR. PR-14 KM 1.2 | ||||||||
| Address2: | |||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2021 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.