Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00672 | PR |
N | 225CX0006X | Orientation and Mobility Training Provider | 00672 | PR |
NPI | 1326607441 |
---|---|
Provider Name | Mayra Berrios |
First Address | Ciales, PR 00638-0696 |
Second Address | Ciales, PR 00638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100006413 | ID NUMBER (01) | PR |