Basic Information
| Provider Information | |||||||||
| NPI: | 1457511131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIGUEROA VEGA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 367221 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009367221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877539515 | ||||||||
| FaxNumber: | 7877538327 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE GAUTIER BENITEZ CONSOLIDATED MALL | ||||||||
| Address2: | ANEXO B 5 | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877040870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 2848 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.