Healthcare Provider Details

I. General information

NPI: 1629051388
Provider Name (Legal Business Name): CARMEN M BERRIOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDOS 65 INFANTERIC KM 1 HM 3.4, BARRIO SABANA ILANA
SAN JUAN PR
00924
US

IV. Provider business mailing address

HC 73 BOX 6190
CAYEY PR
00736-9804
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7676
  • Fax: 787-764-9904
Mailing address:
  • Phone: 787-263-7144
  • Fax: 717-764-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number6176
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: