Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 5738 | PR |
N | 103G00000X | Clinical Psychologist | 5738 | PR |
N | 103TC0700X | Clinical Psychologist | 5738 | PR |
NPI | 1104379320 |
---|---|
Provider Name | Dr. Jaisselle Marie Vega Rosaly |
First Address | Ponce, PR 00716-2610 |
Second Address | Ponce, PR 00716-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 25/07/2016 |