Healthcare Provider Details

I. General information

NPI: 1477461135
Provider Name (Legal Business Name): NINOSHKA RIVERA VARGAS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CALLE DE LA CANDELARIA W
MAYAGUEZ PR
00680-3940
US

IV. Provider business mailing address

CALLE DE LA CANDELARIA #52 OESTE
MAYAGUEZ PR
00681-0701
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-0401
  • Fax:
Mailing address:
  • Phone: 787-805-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8863
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: