Healthcare Provider Details

I. General information

NPI: 1366201634
Provider Name (Legal Business Name): JOSE R NUNEZ MACEIRA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 8.2 BO JUAN SANCHEZ
BAYAMON PR
00957
US

IV. Provider business mailing address

K9 CALLE D
BAYAMON PR
00957-2220
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7575
  • Fax:
Mailing address:
  • Phone: 939-408-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6849
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: