Provider Demographics
NPI:1396456760
Name:VARGAS RODRIGUEZ, YEIZALEE (DRA)
Entity type:Individual
Prefix:
First Name:YEIZALEE
Middle Name:
Last Name:VARGAS RODRIGUEZ
Suffix:
Gender:F
Credentials:DRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 URB LA ALBORADA
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9998
Mailing Address - Country:US
Mailing Address - Phone:787-214-3128
Mailing Address - Fax:
Practice Address - Street 1:LOCAL #4 EDF YOED
Practice Address - Street 2:CALLE LUIS MUNOZ RIVERA #39
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-214-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical