Healthcare Provider Details

I. General information

NPI: 1811494438
Provider Name (Legal Business Name): DANIEL BERRIOS BONES LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A N/A

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 AVE DE DIEGO
SAN JUAN PR
00927-6310
US

IV. Provider business mailing address

PO BOX 191147
SAN JUAN PR
00919-1147
US

V. Phone/Fax

Practice location:
  • Phone: 787-596-0358
  • Fax:
Mailing address:
  • Phone: 787-596-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number000217
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number000217
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number000217
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: