Healthcare Provider Details

I. General information

NPI: 1679418404
Provider Name (Legal Business Name): CHRISTIAN RAUL PEDRAJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. PUERTO REAL
CABO ROJO PR
00623
US

IV. Provider business mailing address

9-23 AVENIDA UNIVERSIDAD INTERAMERICANA
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-357-7488
  • Fax:
Mailing address:
  • Phone: 787-892-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8004
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: