MEDICARE: NERIALIS VAZQUEZ LCDA

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	103TC1900X	Counseling Psychologist	8943	PR

General Provider Information

NPI Number	:	1437005311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERIALIS VAZQUEZ LCDA

Provider Business Mailing Address
First Line	:	PO BOX 3842
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-3842
Country	:	US
Telephone Number	:	787-831-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CALLE MENDEZ VIGO ESTE, ESQUINA CALLE ORIENTE
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-5642
Country	:	US
Telephone Number	:	787-831-1632
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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