=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104598440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDY MENDEZ VAZQUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2021
-----------------------------------------------------
Last Update Date | 10/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 CONDOMINIO DARLINGTON AVE LUIS MUNOZ RIVERA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-342-1320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 CONDOMINIO PORTALES ALBELI BUZON 704
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-342-1320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4186
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------