Healthcare Provider Details

I. General information

NPI: 1447016092
Provider Name (Legal Business Name): KYRIAH A CUEBAS LOPEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE DOMENECH STE 403
SAN JUAN PR
00918-3748
US

IV. Provider business mailing address

400 AVE DOMENECH STE 403
SAN JUAN PR
00918-3748
US

V. Phone/Fax

Practice location:
  • Phone: 787-404-1800
  • Fax:
Mailing address:
  • Phone: 787-404-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6763
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: