Provider Demographics
NPI:1033269139
Name:CHICO NOLLA, VYMAGDA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:VYMAGDA
Middle Name:
Last Name:CHICO NOLLA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 AVE JOSE CEDENO
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3935
Mailing Address - Country:US
Mailing Address - Phone:787-879-1121
Mailing Address - Fax:787-879-1121
Practice Address - Street 1:543 AVE JOSE CEDENO
Practice Address - Street 2:SUITE 204
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3935
Practice Address - Country:US
Practice Address - Phone:787-879-1121
Practice Address - Fax:787-879-1121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR56791CHOtherTRIPLE SSS
PR56791CHOtherTRIPLE SSS OPTIMO
PR2687OtherAPS T- REFORMA
PR2646OtherHUMANA APS
PRPS-1006OtherPALIC
PR528111OtherMCS (PAE) (FHC)
PR528111OtherPMC (FHC)
PR528111OtherTRIPLE SSS FEDERAL
PRP844OtherIMC FIRTS MEDICAL
PR2687OtherAPS T- REFORMA