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General NPI Number Information
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NPI Number | 1518758804
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Entity Type | Organization
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Legal Business Name | MEDINA VAZQUEZ PSYCHOLOGIST LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | CARR 2 INT 417 EDF PUCHO POOL LOCAL 202 BASE #16 BO GUANABANO
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 939-630-7208
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 591
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City | MOCA
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State | PR
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Zip | 00676-0591
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Country | US
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Telephone | 939-630-7208
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | AMNERIS MEDINA VAZQUEZ
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Credential | DRA
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Telephone | 939-630-7208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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