Provider Demographics
NPI:1841076411
Name:VEGA-GUZMAN, JANICE MARIE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:VEGA-GUZMAN
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:HC 58 BOX 14101
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9907
Mailing Address - Country:US
Mailing Address - Phone:787-546-7353
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2929
Practice Address - Country:US
Practice Address - Phone:787-826-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical