Provider Demographics
NPI:1720770811
Name:VEGA RAMOS, ANDRES RAFAEL (MS)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:RAFAEL
Last Name:VEGA RAMOS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W DUBLIN DR APT 403
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29495 COPPERHEAD LN
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-5931
Practice Address - Country:US
Practice Address - Phone:787-205-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist