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General NPI Number Information
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NPI Number | 1366028094
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Entity Type | Individual
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Provider Name | JESSICA MARIE PEREZ CABAN PSYD.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 100 AVE NATIVO ALERS PLAZA COPPELIA L108 BO PIEDRAS BLANCAS SECTOR DESVIO SUR
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 939-349-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 100 AVE NATIVO ALERS STE 110
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City | AGUADA
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State | PR
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Zip | 00602-3418
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Country | US
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Telephone | 939-349-1682
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6867
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License Number State | PR
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