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LICINIA VEGUILLA

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
147 RT 37 WEST, TOMS RIVER, NJ 08755
(732) 341-8885
(732) 341-7408
Mailing address
147 RT 37 WEST, TOMS RIVER, NJ 08755
(752) 341-8885
(732) 341-7408

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA05628100
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7220901
NJ
Enumeration date
04/19/2006
Last updated
03/07/2023
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