Healthcare Provider Details

I. General information

NPI: 1194813345
Provider Name (Legal Business Name): DEBORAH PEREZ-MOJICA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 AVE DOMENECH SUITE 108
SAN JUAN PR
00918-3523
US

IV. Provider business mailing address

PO BOX 11396
SAN JUAN PR
00922-1396
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-3029
  • Fax: 787-792-9991
Mailing address:
  • Phone: 787-758-3029
  • Fax: 787-792-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1409
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1409
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: