Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6078 | PR |
N | 103T00000X | Psychologist | 6078 | PR |
Y | 103TC1900X | Counseling Psychologist | 6078 | PR |
NPI | 1053899971 |
---|---|
Provider Name | Ms. Jessica Martinez |
First Address | Gurabo, PR 00778-9686 |
Second Address | Gurabo, PR 00778-9686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 02/08/2018 |