Provider Demographics
NPI:1720868920
Name:BURGOS-VEGA, PEDRO SR (CSW)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:BURGOS-VEGA
Suffix:SR
Gender:M
Credentials:CSW
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 984
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0984
Mailing Address - Country:US
Mailing Address - Phone:939-294-8898
Mailing Address - Fax:
Practice Address - Street 1:ROAD 901 KM 8.8
Practice Address - Street 2:CAMINO VICENTE DEL MORAL
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0984
Practice Address - Country:US
Practice Address - Phone:939-294-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR136411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical