Provider Demographics
NPI:1205960580
Name:ABAC VEGA, WANDA I
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:I
Last Name:ABAC VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 373184
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-3184
Mailing Address - Country:US
Mailing Address - Phone:787-738-3269
Mailing Address - Fax:787-738-3269
Practice Address - Street 1:CARIBBEAN CINEMA BUILDING 2ND FLOOR
Practice Address - Street 2:SUITE 206 PLAZA CAYEY SHOPPING CENTER
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-3269
Practice Address - Fax:787-738-3269
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist