Healthcare Provider Details

I. General information

NPI: 1164317541
Provider Name (Legal Business Name): PAOLA VEGA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 AVE PONCE DE LEON COBIANS PLAZA SUITE 105
SAN JUAN PR
00909-1812
US

IV. Provider business mailing address

518 CALLE CARLOTA MATIENZO
SAN JUAN PR
00918-3229
US

V. Phone/Fax

Practice location:
  • Phone: 939-252-0280
  • Fax:
Mailing address:
  • Phone:
  • Fax: 939-252-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9226
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: