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General NPI Number Information
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NPI Number | 1093255960
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Entity Type | Individual
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Provider Name | JOABDELITZA MAHMUD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | C27 CALLE SAN LUCAS URB SAN PEDRO
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-204-3759
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Fax |
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Provider Business Mailing Address
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Address Line | C27 CALLE SAN LUCAS URB SAN PEDRO
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22520
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 14459
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7374
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License Number State | PR
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