Healthcare Provider Details

I. General information

NPI: 1073693784
Provider Name (Legal Business Name): ELBA ISABEL MENENDEZ BRUNET PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA ITURREGUI SUITE 217-A
SAN JUAN PR
00926-0000
US

IV. Provider business mailing address

PLAZA ITURREGUI SUITE 217-A
SAN JUAN PR
00926-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-5501
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-768-5501
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002130
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: