Provider Demographics
NPI:1215490255
Name:VARGAS CRUZ, KIOMARA IVELISSE (MA)
Entity type:Individual
Prefix:
First Name:KIOMARA
Middle Name:IVELISSE
Last Name:VARGAS CRUZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CC9 CALLE 138
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2023
Mailing Address - Country:US
Mailing Address - Phone:787-598-5832
Mailing Address - Fax:
Practice Address - Street 1:CC9 CALLE 138
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-2023
Practice Address - Country:US
Practice Address - Phone:787-598-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist