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General NPI Number Information
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NPI Number | 1275676108
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Entity Type | Organization
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Legal Business Name | RED METROPOLITANA DE PSICOLOGIA, CSP
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 607 AVE CONDADO CONDOMINIO CONDADO SUITE 401
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City | SANTURCE
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State | PR
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Zip | 00907-3845
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Country | US
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Telephone | 787-725-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 607 AVE CONDADO CONDOMINIO CONDADO SUITE 401
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City | SANTURCE
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State | PR
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Zip | 00907-3845
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Country | US
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Telephone | 787-725-5013
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. DOMINGO J. MARQUES
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Credential | PSY. D.
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Telephone | 787-725-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2762
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License Number State | PR
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