Provider Demographics
NPI:1164494472
Name:VEGA VILLAVICENCIO, DORIS (MPH,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:VEGA VILLAVICENCIO
Suffix:
Gender:F
Credentials:MPH,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SS3 CALLE 35
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4748
Mailing Address - Country:US
Mailing Address - Phone:787-785-9683
Mailing Address - Fax:787-785-9683
Practice Address - Street 1:SS3 CALLE 35
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4748
Practice Address - Country:US
Practice Address - Phone:787-785-9683
Practice Address - Fax:787-785-9683
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR422225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6605720151OtherMCS
PR890461OtherMEDICARE Y MUCHO MAS
PRS50584Medicare UPIN
PR890461OtherMEDICARE Y MUCHO MAS