1881908499 NPI number — DR. JEANETTE TORRES PEREZ PSYD

Table of content: DR. JEANETTE TORRES PEREZ PSYD (NPI 1881908499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881908499 NPI number — DR. JEANETTE TORRES PEREZ PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRES PEREZ
Provider First Name:
JEANETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881908499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367922
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-644-5219
Provider Business Mailing Address Fax Number:
787-848-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE RAMON EMETERIO BETANCES
Provider Second Line Business Practice Location Address:
296 SUR SUITE 1
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-644-5219
Provider Business Practice Location Address Fax Number:
787-848-0318
Provider Enumeration Date:
08/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3693 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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