Healthcare Provider Details

I. General information

NPI: 1720903164
Provider Name (Legal Business Name): JASLY MARIE RODRIGUEZ VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 AVE INTERAMERICANA
SAN GERMAN PR
00683
US

IV. Provider business mailing address

EST DEL RIO CALLE RIO CANAS 14
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-3333
  • Fax:
Mailing address:
  • Phone: 939-835-4137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number873
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: