MEDICARE: MISS BRENDA L PAGAN VEGA MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13254	PR

General Provider Information

NPI Number	:	1124603931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRENDA L PAGAN VEGA MSW

Provider Business Mailing Address
First Line	:	PO BOX 1953
Second Line	:
City	:	YAUCO
State	:	PR
Zip	:	00698-1953
Country	:	US
Telephone Number	:	939-224-1739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2162 BLVD. LUIS A. FERRE
Second Line	:	URB. VILLA GRILLASCA
City	:	PONCE
State	:	PR
Zip	:	00717-0722
Country	:	US
Telephone Number	:	939-224-1739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	04/16/2026

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