Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 006406 | PR |
NPI | 1073161865 |
---|---|
Provider Name | Miss Myriam I. Perez |
First Address | San Juan, PR 00918-4151 |
Second Address | San Juan, PR 00927-4309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |