Provider Demographics
NPI:1235833351
Name:VEGA SEPULVEDA, YARITZA
Entity Type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:VEGA SEPULVEDA
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 1:445 GONZALEZ CLEMENT AVE
Mailing Address - Street 2:CARR 104 KM 5.4 BO GUANAJIBO SUITE 215
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:939-344-6840
Mailing Address - Fax:
Practice Address - Street 1:445 GONZALEZ CLEMENT AVE
Practice Address - Street 2:CARR 104 KM 5.4 BO GUANAJIBO SUITE 215
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-344-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5615103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent