Healthcare Provider Details

I. General information

NPI: 1902969611
Provider Name (Legal Business Name): JORGE ERNESTO BERRIOS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE STE 307 SAN JORGE MEDICAL BUILDING
SAN JUAN PR
00912-3240
US

IV. Provider business mailing address

PO BOX 7558
CAGUAS PR
00726-7558
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-7775
  • Fax: 787-728-7755
Mailing address:
  • Phone: 787-370-8964
  • Fax: 787-743-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2724
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2724
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: