Provider Demographics
NPI:1508127440
Name:VEGA, ROBERTO (MSW)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0980
Mailing Address - Country:US
Mailing Address - Phone:787-201-5200
Mailing Address - Fax:
Practice Address - Street 1:URB. PORTO FINO CALLE AGUA VIVA I-6
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0980
Practice Address - Country:US
Practice Address - Phone:787-201-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7273104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker