Healthcare Provider Details

I. General information

NPI: 1679394969
Provider Name (Legal Business Name): ONIRIC PSYCHOLOGY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO ISABELINO DE MEDICINA AVANZADA (CIMA) SUITE 11
ISABELA PR
00662
US

IV. Provider business mailing address

HC 3 BOX 8349
LARES PR
00669-9573
US

V. Phone/Fax

Practice location:
  • Phone: 939-254-0727
  • Fax:
Mailing address:
  • Phone: 939-254-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE A PEREZ AROCHO
Title or Position: PSYCHOLOGIST
Credential: MA
Phone: 787-356-6130