Healthcare Provider Details

I. General information

NPI: 1922705714
Provider Name (Legal Business Name): EMILIE OQUENDO MS, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CALLE 6 NE
SAN JUAN PR
00920-2512
US

IV. Provider business mailing address

F9 CALLE 9
BAYAMON PR
00956-2663
US

V. Phone/Fax

Practice location:
  • Phone: 939-745-2689
  • Fax:
Mailing address:
  • Phone: 939-745-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7585
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: