Organization
MENTE ACTIVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAISSELLE MARIE VEGA PHD (EXECUTIVE DIRECTOR)
(787) 677-0503
Entity
Organization
Contact information
Practice address
775 CALLE CAOBA, CENTRO COMERCIAL LOS CAOBOS, SUITE 10, PONCE, PR 00716-2610
(787) 677-0503
Mailing address
775 CALLE CAOBA, CENTRO COMERCIAL LOS CAOBOS, SUITE 10, PONCE, PR 00716-2610
(787) 677-0503
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Enumeration date
07/25/2016
Last updated
04/17/2021
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