Provider Demographics
NPI:1629449764
Name:VEGA CONCEPCION, KARINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:
Last Name:VEGA CONCEPCION
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6876
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9764
Mailing Address - Country:US
Mailing Address - Phone:787-232-1608
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6876
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9764
Practice Address - Country:US
Practice Address - Phone:787-232-1608
Practice Address - Fax:787-545-2400
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4227103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist