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General NPI Number Information
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NPI Number | 1285443580
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Entity Type | Individual
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Provider Name | JORGE EDUARDO BURGOS CAPESTANY
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Gender | Male
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | CALLE TORRES 77C
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City | PONCE, PR
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State | PR
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Zip | 00730
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Country | US
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Telephone | 787-627-4267
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Fax |
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Provider Business Mailing Address
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Address Line | SAN ANTONIO CALLE DRAMA 2043
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City | PONCE, PR
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-627-4267
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7319
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License Number State | PR
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