1265643886 NPI number — NEICY MARIVI MUNOZ MORALES PSY.D

Table of content: NEICY MARIVI MUNOZ MORALES PSY.D (NPI 1265643886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265643886 NPI number — NEICY MARIVI MUNOZ MORALES PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ MORALES
Provider First Name:
NEICY
Provider Middle Name:
MARIVI
Provider Name Prefix Text:
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:
1265643886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 383
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754-0383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-763-7575
Provider Business Mailing Address Fax Number:
787-765-7104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE PINO 2D33
Provider Second Line Business Practice Location Address:
URB. VILLAS DEL REY
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:
787-718-7596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2007

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:  1511 , 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)

  • Identifier: 001511 . This is a "JUNTA EXAMINADORA DE PSICOLOGOS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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