Provider Demographics
NPI:1073393302
Name:VEGA, YADIRA CAROLINA
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:CAROLINA
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 1:4145 SW WATSON AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2191
Mailing Address - Country:US
Mailing Address - Phone:971-417-6054
Mailing Address - Fax:
Practice Address - Street 1:4145 SW WATSON AVE STE 350
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2191
Practice Address - Country:US
Practice Address - Phone:971-417-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health