Healthcare Provider Details

I. General information

NPI: 1033025952
Provider Name (Legal Business Name): CECILIA MARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND CENTRUM PLZ 1B
SAN JUAN PR
00917
US

IV. Provider business mailing address

6050 CARR 844 APT 35
SAN JUAN PR
00926-7816
US

V. Phone/Fax

Practice location:
  • Phone: 787-565-3287
  • Fax:
Mailing address:
  • Phone: 787-565-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6820
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: