MEDICARE: DR. NADIA ENID RIVERA VEGA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6125	PR

General Provider Information

NPI Number	:	1356103071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADIA ENID RIVERA VEGA PHD

Provider Business Mailing Address
First Line	:	3945 CALLE ACEROLA
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2257
Country	:	US
Telephone Number	:	787-988-9868
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 CALLE MAYOR
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-3726
Country	:	US
Telephone Number	:	787-844-3077
Fax Number	:	787-844-3077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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