Provider Demographics
NPI:1962154039
Name:VITALMENTE PSICOLOGIA Y BIENESTAR DRA. IRIS YOLANDA VEGA RIVERA CSP
Entity type:Organization
Organization Name:VITALMENTE PSICOLOGIA Y BIENESTAR DRA. IRIS YOLANDA VEGA RIVERA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA CLINICA
Authorized Official - Prefix:
Authorized Official - First Name:DRA. IRIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-505-2022
Mailing Address - Street 1:VISTA DEL ATLANTICO 96 CALLE MERO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2919
Mailing Address - Country:US
Mailing Address - Phone:787-505-2022
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL REPARTO SAN DANIEL CARR 2 KM 81
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-505-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7292OtherLICENCES