Healthcare Provider Details

I. General information

NPI: 1568663292
Provider Name (Legal Business Name): MARIELY FIGUEROA M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. LA RIVIERA AVE. SAN PATRICIO 1401
RIO PIERDRAS PR
00921
US

IV. Provider business mailing address

19 CALLE ALDRIN SANTA CLARA
JAYUYA PR
00664
US

V. Phone/Fax

Practice location:
  • Phone: 787-380-8346
  • Fax:
Mailing address:
  • Phone: 787-828-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number2649
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: