Healthcare Provider Details

I. General information

NPI: 1427106566
Provider Name (Legal Business Name): MYRNA JOSEFA ZEGARRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON OFFICE #609
SAN JUAN PR
00907-1510
US

IV. Provider business mailing address

29 CALLE WASHINGTON OFFICE #609
SAN JUAN PR
00907-1510
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-0788
  • Fax:
Mailing address:
  • Phone: 787-725-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2897
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2897
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: