Healthcare Provider Details

I. General information

NPI: 1336033992
Provider Name (Legal Business Name): CAROLINE DENISE VEGA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 685 KM 4.5 BO. BOQUILLAS
MANATI PR
00674
US

IV. Provider business mailing address

CARR. 685 KM 4.5 BO. BOQUILLAS
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-466-8911
  • Fax:
Mailing address:
  • Phone: 787-466-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7886
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: