Healthcare Provider Details

I. General information

NPI: 1124371679
Provider Name (Legal Business Name): ROSAURA CHARLEMAN-MORENO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CALLE VENUS URB. EL VERDE
CAGUAS PR
00725-6340
US

IV. Provider business mailing address

38 CALLE VENUS URB. EL VERDE
CAGUAS PR
00725-6340
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax:
Mailing address:
  • Phone: 787-725-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1775
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: