Healthcare Provider Details

I. General information

NPI: 1316488901
Provider Name (Legal Business Name): OXALIS JUSINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5H5 AVE SANCHEZ OSORIO VILLA FONTANA PARK
CAROLINA PR
00982
US

IV. Provider business mailing address

22 CALLE G ESTANCIAS DE MONTE VERDE
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4717
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: