Healthcare Provider Details

I. General information

NPI: 1841322914
Provider Name (Legal Business Name): RAQUEL BERRIOS LND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PEDIATRICO DEPT SALUD
PONCE PR
00730
US

IV. Provider business mailing address

PO BOX 8000972
COTO LAUREL PR
00780-0972
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7170
  • Fax:
Mailing address:
  • Phone: 787-840-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number354
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLNB354
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: