Healthcare Provider Details

I. General information

NPI: 1962154039
Provider Name (Legal Business Name): VITALMENTE PSICOLOGIA Y BIENESTAR DRA. IRIS YOLANDA VEGA RIVERA CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 06/30/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL REPARTO SAN DANIEL CARR 2 KM 81
ARECIBO PR
00612
US

IV. Provider business mailing address

VISTA DEL ATLANTICO 96 CALLE MERO
ARECIBO PR
00612-2919
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-2022
  • Fax:
Mailing address:
  • Phone: 787-505-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DRA. IRIS Y VEGA
Title or Position: PSICOLOGA CLINICA
Credential: PSY.D.
Phone: 787-505-2022