Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3159 | PR |
Y | 103TC0700X | Clinical Psychologist | 3159 | PR |
NPI | 1013161025 |
---|---|
Provider Name | Dr. Maricruz Rosario Clemente |
First Address | Lares, PR 00669 |
Second Address | Cigles, PR 00638-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 10/11/2008 |