Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 656 | PR |
NPI | 1922581081 |
---|---|
Provider Name | Marisol Baerga |
First Address | San Juan, PR 00926 |
Second Address | Manati, PR 00674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 13/09/2018 |