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General NPI Number Information
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NPI Number | 1649352592
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Entity Type | Individual
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Provider Name | JESSICA UJAQUE
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | AVE. DEGETAU F-4
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-744-7783
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Fax |
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Provider Business Mailing Address
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Address Line | 119 CALLE LOS TAINOS
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City | MAYAGUEZ
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State | PR
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Zip | 00682-6351
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Country | US
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Telephone | 939-630-9588
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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 | 2450
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License Number State | PR
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