Basic Information
Provider Information
NPI: 1629682364
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VEGA GONZALEZ
FirstName: BERBELYZE
MiddleName: NOMAR
NamePrefix: DR.
NameSuffix:  
Credential: PHAM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 668 CALLE CUBITA
Address2: LOS FRAILES INDUSTRIAL PARK
City: GUAYNABO
State: PR
PostalCode: 00969
CountryCode: US
TelephoneNumber: 7877877733
FaxNumber:  
Practice Location
Address1: 128 CALLE LUNA
Address2:  
City: CAROLINA
State: PR
PostalCode: 009791705
CountryCode: US
TelephoneNumber: 7877915757
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2020
LastUpdateDate: 09/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X6604PRY Pharmacy Service ProvidersPharmacist 

No ID Information.


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