Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5964 | PR |
NPI | 1013413848 |
---|---|
Provider Name | Lyann Ojeda |
First Address | San Juan, PR 00926-2905 |
Second Address | San Juan, PR 00926-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
512698659 | PASSPORT (01) | PR |