Provider Demographics
NPI:1073128047
Name:VEGA, BIANCA PAOLA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:PAOLA
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO PRADOS DEL MONTE
Mailing Address - Street 2:29 CALLE BASILIO CATALA APTM 106
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-421-6130
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE SANTA CRUZ STE 405
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6942
Practice Address - Country:US
Practice Address - Phone:787-421-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty