Provider Demographics
NPI:1548029242
Name:CARTAGENA VEGA, AMISAEL
Entity type:Individual
Prefix:
First Name:AMISAEL
Middle Name:
Last Name:CARTAGENA 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:URB BAIROA PARK
Mailing Address - Street 2:CALLE JULIO ALDRICH 2B4
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-404-2767
Mailing Address - Fax:
Practice Address - Street 1:URB BAIROA PARK
Practice Address - Street 2:CALLE JULIO ALDRICH 2B4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-404-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4564183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician