Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 7012 | PR |
Y | 103T00000X | Psychologist | 7012 | PR |
NPI | 1003573106 |
---|---|
Provider Name | Ms. Giasselle A Limery-Nieves |
First Address | San Juan, PR 00915-4312 |
Second Address | Guaynabo, PR 00969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2021 |
Last Update Date | 23/11/2021 |