Healthcare Provider Details

I. General information

NPI: 1568771129
Provider Name (Legal Business Name): MAYRA R SEDA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARQUE CENTRO 900 CERRA ST
SAN JUAN PR
00918-5000
US

IV. Provider business mailing address

897 CALLE ALAMEDA APT 601
SAN JUAN PR
00923-2446
US

V. Phone/Fax

Practice location:
  • Phone: 787-344-8698
  • Fax:
Mailing address:
  • Phone: 787-344-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1312
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: