Provider Demographics
NPI:1255185500
Name:SANTIAGO VEGA, NAIDYMAR
Entity type:Individual
Prefix:
First Name:NAIDYMAR
Middle Name:
Last Name:SANTIAGO VEGA
Suffix:
Gender:
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 1605
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-4605
Mailing Address - Country:US
Mailing Address - Phone:787-526-2172
Mailing Address - Fax:
Practice Address - Street 1:E22 CALLE 15A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5734
Practice Address - Country:US
Practice Address - Phone:787-526-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional