Provider Demographics
NPI:1356103071
Name:RIVERA VEGA, NADIA ENID (PHD)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:ENID
Last Name:RIVERA VEGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 CALLE ACEROLA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2257
Mailing Address - Country:US
Mailing Address - Phone:787-988-9868
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3726
Practice Address - Country:US
Practice Address - Phone:787-844-3077
Practice Address - Fax:787-844-3077
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical