Healthcare Provider Details

I. General information

NPI: 1790993384
Provider Name (Legal Business Name): ZAIDA MONCLOVA BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA CDT GUALBERTO RABELL
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

110 CALLE EMAJAGUILLA URB. LOS FLAMBOYANES
GURABO PR
00778-2765
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-3220
  • Fax: 787-721-3207
Mailing address:
  • Phone: 787-903-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number20980
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: