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General NPI Number Information
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NPI Number | 1922262369
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Entity Type | Organization
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Legal Business Name | SERVICIOS PROFESIONALES DE MEDIACION
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 135 AVE MUNOZ RIVERA E STE 2
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City | CAMUY
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State | PR
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Zip | 00627-2630
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Country | US
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Telephone | 787-897-2705
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Fax | 787-897-6728
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Provider Business Mailing Address
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Address Line | PO BOX 1455
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City | LARES
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State | PR
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Zip | 00669-1455
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Country | US
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Telephone | 787-897-2705
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Fax | 787-897-6728
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ANGEL RAFAEL EGOZCUE
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Credential | PH.D
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Telephone | 787-897-2705
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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 | 0372
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License Number State | PR
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