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General NPI Number Information
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NPI Number | 1629952478
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Entity Type | Individual
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Provider Name | OTTO AGUSTIN BERDIEL MS
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Gender | Male
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1801 AVE PONCE DE LEON STE 411
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City | SAN JUAN
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State | PR
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Zip | 00909-1917
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Country | US
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Telephone | 787-509-6100
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Fax | 787-292-0521
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Provider Business Mailing Address
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Address Line | 70 VIA ROMA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-6105
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Country | US
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Telephone | 787-509-6100
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Fax | 787-292-0521
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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 | 831
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License Number State | PR
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