Basic Information
| Provider Information | |||||||||
| NPI: | 1942467030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | BRENDALIZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 CALLE CAOBO | ||||||||
| Address2: | |||||||||
| City: | SANTA ISABEL | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007572058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875624607 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 CALLE GUADALUPE | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007303561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877094130 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2008 | ||||||||
| LastUpdateDate: | 09/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3065 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.