Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 37192 | TX |
NPI | 1447737135 |
---|---|
Provider Name | Marlene Vega |
First Address | Dallas, TX 75390-9055 |
Second Address | Dallas, TX 75390-9055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |