Individual
CARLOS MIGUEL VEGUILLA DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
1314 MAIN ST, BETHLEHEM, PA 18018-2314
(787) 438-2841
Mailing address
1314 MAIN ST, BETHLEHEM, PA 18018-2314
(787) 438-2841
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT007298
PA
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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