Healthcare Provider Details

I. General information

NPI: 1598673170
Provider Name (Legal Business Name): JESENIA LORRAINE VEGERANO HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA DEL ESTE MODENA III BUILDING 11 APARTMENT 322
GURABO PR
00778
US

IV. Provider business mailing address

VILLA DEL ESTE 1370 CARR 203 APT 245
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 939-294-0945
  • Fax:
Mailing address:
  • Phone: 939-294-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4799
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: