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General NPI Number Information
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NPI Number | 1457908063
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Entity Type | Individual
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Provider Name | MARIZEL BURGOS MARTINEZ PSY.D
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Gender | Female
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 867 AVE MUNOZ RIVERA STE B102
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City | RIO PIEDRAS
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State | PR
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Zip | 00925-2109
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Country | US
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Telephone | 939-402-1334
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10734 CAPARRA HEIGHTS STATION
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City | SAN JUAN
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State | PR
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Zip | 00922-0734
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Country | US
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Telephone | 939-402-1334
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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 | 5768
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License Number State | PR
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