Provider Demographics
NPI:1356902332
Name:VEGA RIVERA, KARYLIN RAQUEL
Entity type:Individual
Prefix:
First Name:KARYLIN
Middle Name:RAQUEL
Last Name:VEGA RIVERA
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:URBANIZACION PASEO DE LA CEIBA
Mailing Address - Street 2:164 CALLE ARCE
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-637-7674
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE DUFRESNE E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3605
Practice Address - Country:US
Practice Address - Phone:787-852-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9334104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker