Healthcare Provider Details

I. General information

NPI: 1871293670
Provider Name (Legal Business Name): CRISTINA MARIE VAZQUEZ RIOS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. MARICAO SECT. BAJURA VEGA ALTA
PUERTO RICO PR
00692-0069
US

IV. Provider business mailing address

28 CALLE 16
VEGA BAJA PR
00693-3702
US

V. Phone/Fax

Practice location:
  • Phone: 787-436-4364
  • Fax:
Mailing address:
  • Phone: 787-436-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7646
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: