Provider Demographics
NPI:1518266311
Name:VEGA, MARIEL (MS SLP)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ATENAS 1300 URBANIZACION MONTE ATENAS
Mailing Address - Street 2:APT. 307
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-204-7514
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION FAIR VIEW MARGINAL
Practice Address - Street 2:CALLE 2 D-4
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-204-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist