Healthcare Provider Details

I. General information

NPI: 1841154119
Provider Name (Legal Business Name): KEISHLA VEGA MELENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D12 CALLE MIS AMORES
CAGUAS PR
00725-5821
US

IV. Provider business mailing address

D12 CALLE MIS AMORES
CAGUAS PR
00725-5821
US

V. Phone/Fax

Practice location:
  • Phone: 787-930-3144
  • Fax:
Mailing address:
  • Phone: 787-930-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1884
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: