Provider Demographics
NPI:1861743841
Name:VAZQUEZ RIVERA, NYDIA R (MPCP)
Entity type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:R
Last Name:VAZQUEZ RIVERA
Suffix:
Gender:F
Credentials:MPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CALLE ENSUENO
Mailing Address - Street 2:MANS MONTE VERDE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4152
Mailing Address - Country:US
Mailing Address - Phone:787-636-7425
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE JOSE CELSO BARBOSA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4726
Practice Address - Country:US
Practice Address - Phone:787-738-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4225103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling