Provider Demographics
NPI:1548815376
Name:VEGA DAVILA, REINALDO (RN-MSN)
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:VEGA DAVILA
Suffix:
Gender:M
Credentials:RN-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 5171
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9862
Mailing Address - Country:US
Mailing Address - Phone:787-847-9393
Mailing Address - Fax:787-847-9292
Practice Address - Street 1:CARR 149 KM 57.4 BO TIERRA SANTA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-9393
Practice Address - Fax:787-847-9292
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1941E163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty