Healthcare Provider Details

I. General information

NPI: 1407049687
Provider Name (Legal Business Name): MIGDALIA ZENON MRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. BARBOSA # 414 EDIF. LINCON
SAN JUAN PR
00914
US

IV. Provider business mailing address

CALLE 26 AH 13 EL CORTIJO
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7575
  • Fax:
Mailing address:
  • Phone: 787-316-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number374
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: