Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 1787 | PR |
NPI | 1184381840 |
---|---|
Provider Name | Jackeline Rebollo Lopez |
First Address | Ponce, PR 00780 |
Second Address | Ponce, PR 00780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |