Healthcare Provider Details

I. General information

NPI: 1003721218
Provider Name (Legal Business Name): YASHIRA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 29.4
VEGA ALTA PR
00962
US

IV. Provider business mailing address

BI7 CALLE JALISCO
BAYAMON PR
00956-4907
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-1854
  • Fax:
Mailing address:
  • Phone: 939-232-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8944
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: