1225703812 NPI number — DR. LOURDES RAQUEL BERRIOS ORTIZ PSY.D

Table of content: DR. LOURDES RAQUEL BERRIOS ORTIZ PSY.D (NPI 1225703812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225703812 NPI number — DR. LOURDES RAQUEL BERRIOS ORTIZ PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRIOS ORTIZ
Provider First Name:
LOURDES
Provider Middle Name:
RAQUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
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:
1225703812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 1 BOX 2725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739-9871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-342-0414
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR-1 AVE. SAKURA BAIROA INDUSTRIAL PARK,
Provider Second Line Business Practice Location Address:
OFICINA 235-A
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-705-5565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2021

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:  6739 , 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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