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General NPI Number Information
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NPI Number | 1356152441
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Entity Type | Individual
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Provider Name | YADYRA LEE VEGA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 5726 OLD CHENEY HWY
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City | ORLANDO
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State | FL
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Zip | 32807-3525
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Country | US
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Telephone | 407-900-5278
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Fax | 407-641-2980
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Provider Business Mailing Address
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Address Line | 8745 JAMESTOWN DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-4840
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Country | US
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Telephone | 787-295-5716
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1684
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License Number State | PR
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