Healthcare Provider Details

I. General information

NPI: 1063843373
Provider Name (Legal Business Name): JULIO HERRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #1 RIO PIEDRAS A CAGUAS KM. 24.2
GUAYNABO PR
00969
US

IV. Provider business mailing address

CARR. #1 RIO PIEDRAS A CAGUAS KM 24.2
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-445-1101
  • Fax:
Mailing address:
  • Phone: 787-445-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3766
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number3766
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: