Provider Demographics
NPI:1548306038
Name:ROLANDO DELGADO VEGA
Entity type:Organization
Organization Name:ROLANDO DELGADO VEGA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-425-7824
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1135
Mailing Address - Country:US
Mailing Address - Phone:787-425-7824
Mailing Address - Fax:787-856-5757
Practice Address - Street 1:CAR128 KM 2.2 BO. SUSUA BAJA
Practice Address - Street 2:YAUCO GALLERY SUITE 106
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-425-7824
Practice Address - Fax:787-856-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10171OtherAMERICAN HEALTH MEDICARE
PR6980094OtherHUMANA
PR2151042OtherPREFERRED HEALTH
PR50846OtherPMC
PR890753OtherMMM
PR101952OtherCRUZ AZUL DE PR
PR890753OtherMMM