Healthcare Provider Details

I. General information

NPI: 1417851924
Provider Name (Legal Business Name): CLINICA INTEGRAL DR. ROBERTO NORNIELLA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6772 AVENIDA ISLA VERDE - ISLA VERDE MALL SUITE 205B
CAROLINA PR
00979
US

IV. Provider business mailing address

6772 AVENIDA ISLA VERDE - ISLA VERDE MALL SUITE 205B
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-985-7011
  • Fax:
Mailing address:
  • Phone: 787-985-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERTO VERA NORNIELLA
Title or Position: OWNER
Credential: MD
Phone: 770-572-2176