MEDICARE: ENEIDA VEGA VELAZQUEZ PSICOLOGA

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	103T00000X	Psychologist	8610	PR

General Provider Information

NPI Number	:	1518837020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENEIDA VEGA VELAZQUEZ PSICOLOGA

Provider Business Mailing Address
First Line	:	URBANIZACION EL PEPINO C 57
Second Line	:	CALLE C
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685
Country	:	US
Telephone Number	:	787-387-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	BARRIO VOLADORA CARR. 111 KM 7.1.
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676
Country	:	US
Telephone Number	:	787-633-2233
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	12/04/2025

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Directions to “ ENEIDA VEGA VELAZQUEZ PSICOLOGA” Practice Location

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