Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6882 | PR |
Y | 103TC0700X | Clinical Psychologist | 6882 | PR |
NPI | 1003493339 |
---|---|
Provider Name | Joely Enid Rentas-Rivera |
First Address | Barceloneta, PR 00617-9857 |
Second Address | Carolina, PR 00985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 20/12/2021 |