Provider Demographics
NPI:1780415471
Name:VEGA, LEAMSI REY
Entity type:Individual
Prefix:
First Name:LEAMSI
Middle Name:REY
Last Name:VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 CALLE DIAMANTE
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-5452
Mailing Address - Country:US
Mailing Address - Phone:787-800-5217
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE ESMERALDA
Practice Address - Street 2:LOMAS VERDE
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-800-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008067103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist