Provider Demographics
NPI:1285009688
Name:VEGA, LUZ D
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:D
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 1:207 AVE DOMENECH
Mailing Address - Street 2:SUITE 201 PRO TALENTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-766-0404
Mailing Address - Fax:787-766-9191
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-766-0404
Practice Address - Fax:787-766-9191
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13055104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker