Healthcare Provider Details

I. General information

NPI: 1093360646
Provider Name (Legal Business Name): WILFREDO FIGUEROA-BERRIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33505 SCHOOLCRAFT RD
LIVONIA MI
48150-1630
US

IV. Provider business mailing address

4306 ELIZABETH ST
WAYNE MI
48184-2154
US

V. Phone/Fax

Practice location:
  • Phone: 844-296-2673
  • Fax:
Mailing address:
  • Phone: 734-679-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704290744
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: