Healthcare Provider Details

I. General information

NPI: 1700320512
Provider Name (Legal Business Name): GLENIVETTE ZAYAS-VAZQUEZ PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARR PLAZA CAYEY
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 2003
GUAYNABO PR
00970-2003
US

V. Phone/Fax

Practice location:
  • Phone: 787-679-8922
  • Fax:
Mailing address:
  • Phone: 787-516-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5744
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier005744
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: