Healthcare Provider Details

I. General information

NPI: 1578140026
Provider Name (Legal Business Name): SAMUEL EDUARDO PEREZ RIVERA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VALPARAISO CALLE 3 A-24
TOA BAJA PR
00949
US

IV. Provider business mailing address

URB VALPARAISO CALLE 3 A-24
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-2457
  • Fax:
Mailing address:
  • Phone: 787-248-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSYCT-19-48SPR
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: