Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6257 | PR |
NPI | 1023571700 |
---|---|
Provider Name | Jose Gabriel Payano Pineyro |
First Address | San Juan, PR 00739 |
Second Address | Cidra, PR 00739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 10/04/2019 |