Healthcare Provider Details

I. General information

NPI: 1700716370
Provider Name (Legal Business Name): MAITE JANIRA ECHEVESTRE PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VILLAS SAN AGUSTIN
CAMUY PR
00627-9758
US

IV. Provider business mailing address

210 VILLAS SAN AGUSTIN
CAMUY PR
00627-9758
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-6929
  • Fax:
Mailing address:
  • Phone: 787-460-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4775
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: