Healthcare Provider Details

I. General information

NPI: 1073128047
Provider Name (Legal Business Name): BIANCA VEGA - SANOGUET PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CALLE GONZALEZ GIUSTI STE 206
GUAYNABO PR
00968-3011
US

IV. Provider business mailing address

GG1 CALLE MAGNOLIA
SAN JUAN PR
00926-6337
US

V. Phone/Fax

Practice location:
  • Phone: 787-421-6130
  • Fax:
Mailing address:
  • Phone: 787-421-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6716
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: