Active NPI
Vanessa I. Boglio Martinez, PSY D
- Clinical Psychologist
- Santurce, PR
National Provider Identifier
1831258680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2629
- Practice address
- 1607 Ave Ponce de Leon
Edificion Cobian's Plaza Suite 301
Santurce, PR 00909-1820 - Phone
- (787) 236-8733
- NPI assigned
- Dec 7, 2006
- Last updated
- Aug 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2629 | PR | Primary |
Addresses
Primary practice location
1607 Ave Ponce de Leon
Edificion Cobian's Plaza Suite 301
Santurce, PR 00909-1820
Mailing address
1019 Ave Luis Vigoreaux
Condominio Doral Plaza I Apt. E-2
Guaynabo, PR 00966-2400
Phone (787) 236-8733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070222000048 | PR | Practitioner - Clinical Psychologist | 0547362543 | Practice locations: San Juan, PR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2629 | PR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503360000000",
"number": "1831258680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 AVE LUIS VIGOREAUX",
"address_2": "CONDOMINIO DORAL PLAZA I APT. E-2",
"city": "GUAYNABO",
"state": "PR",
"postal_code": "009662400",
"telephone_number": "787-236-8733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1607 AVE PONCE DE LEON",
"address_2": "EDIFICION COBIAN'S PLAZA SUITE 301",
"city": "SANTURCE",
"state": "PR",
"postal_code": "009091820",
"telephone_number": "787-236-8733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGLIO MARTINEZ",
"first_name": "VANESSA",
"middle_name": "I.",
"name_prefix": "Dr.",
"credential": "PSY D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-07",
"last_updated": "2017-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "2629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santurce, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.