Healthcare Provider Details

I. General information

NPI: 1366165201
Provider Name (Legal Business Name): JOANNA M PEREIRA-ROMERO MCPL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 967 KM. 1.3 SECTOR LAS 3T
RIO GRANDE PR
00745-2086
US

IV. Provider business mailing address

PO BOX 2086
RIO GRANDE PR
00745-2086
US

V. Phone/Fax

Practice location:
  • Phone: 939-645-0391
  • Fax:
Mailing address:
  • Phone: 939-645-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2109
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: