Provider Demographics
NPI:1861362865
Name:MATIAS VEGA, MARIA ISABEL
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:MATIAS 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:PO BOX 2113
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2113
Mailing Address - Country:US
Mailing Address - Phone:939-286-4047
Mailing Address - Fax:
Practice Address - Street 1:CARR. 111 KM 5.1 CALLE JUAN SAN ANTONIO, BO PUEBLO
Practice Address - Street 2:EDIFICIO 207
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist