Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 7015 | PR |
NPI | 1093388753 |
---|---|
Provider Name | Saryvette Maldonado |
First Address | Bayamon, PR 00961-7069 |
Second Address | Bayamon, PR 00961-7069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2021 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4444762 | DRIVER ID (01) | PR |