Healthcare Provider Details

I. General information

NPI: 1164989018
Provider Name (Legal Business Name): AIXA NEGRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CALLE TANCA
SAN JUAN PR
00901
US

IV. Provider business mailing address

151 CALLE TANCA
SAN JUAN PR
00901-3711
US

V. Phone/Fax

Practice location:
  • Phone: 121-725-6500
  • Fax:
Mailing address:
  • Phone: 787-725-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4715
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: