Healthcare Provider Details

I. General information

NPI: 1174209159
Provider Name (Legal Business Name): AMANDA PEREZ PEREZ CABRERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M1C/ PRINCIPAL URB. TOA ALTA HEIGHTS
TOA ALTA PR
00953
US

IV. Provider business mailing address

PO BOX 491
NARANJITO PR
00719
US

V. Phone/Fax

Practice location:
  • Phone: 939-494-0004
  • Fax:
Mailing address:
  • Phone: 787-614-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7731
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: