Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6004 | PR |
NPI | 1003308818 |
---|---|
Provider Name | Melanie Vargas Santiago |
First Address | San Juan, PR 00920-4161 |
Second Address | San Juan, PR 00920-4161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 06/06/2018 |