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General NPI Number Information
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NPI Number | 1083491336
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Entity Type | Individual
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Provider Name | MYRTELINA MERINO VEGA M. PSY.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | C-27 VIA DEL SOL VALLE DE SAN LUIS
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City | CAGUAS
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State | PR
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Zip | 00725-3347
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Country | US
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Telephone | 787-435-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 119 VIA DEL SOL VALLE DE SAN LUIS
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City | CAGUAS
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State | PR
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Zip | 00725-3347
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Country | US
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Telephone | 787-435-7545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3785
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License Number State | PR
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