Basic Information
Provider Information | |||||||||
NPI: | 1013190008 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VEGA RIOS | ||||||||
FirstName: | VIMARI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | AJ12 CALLE 26 | ||||||||
Address2: |   | ||||||||
City: | TRUJILLO ALTO | ||||||||
State: | PR | ||||||||
PostalCode: | 009763424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7873819116 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | EDIFICIO CENTURION PISO 3 CARR. #2 KM 11.8 | ||||||||
Address2: |   | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 00961 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7879952700 | ||||||||
FaxNumber: | 7879952706 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2007 | ||||||||
LastUpdateDate: | 09/06/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.