Provider Demographics
NPI:1003594722
Name:ROSARIO VEGA, EVELYN (MSLP)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:ROSARIO VEGA
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CALLE ATENAS APT 32
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7808
Mailing Address - Country:US
Mailing Address - Phone:787-460-5120
Mailing Address - Fax:
Practice Address - Street 1:CALLE MIKONOS C#1
Practice Address - Street 2:URB. MONTE ATENAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-460-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist