Provider Demographics
NPI:1083491336
Name:MERINO VEGA, MYRTELINA (M PSY)
Entity Type:Individual
Prefix:
First Name:MYRTELINA
Middle Name:
Last Name:MERINO VEGA
Suffix:
Gender:F
Credentials:M PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 VIA DEL SOL
Mailing Address - Street 2:VALLE DE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3347
Mailing Address - Country:US
Mailing Address - Phone:787-435-7545
Mailing Address - Fax:
Practice Address - Street 1:C-27 VIA DEL SOL
Practice Address - Street 2:VALLE DE SAN LUIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3347
Practice Address - Country:US
Practice Address - Phone:787-435-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3785103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling