MEDICARE: JUANA P CASTILLO MUNOZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	005405	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005405	OTHER	PR	PUERTO RICO PHSICOLOGIST LICENCE
2	160126	OTHER	PR	REGISTRY NUMBER

General Provider Information

NPI Number	:	1679087795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA P CASTILLO MUNOZ PH.D.

Provider Business Mailing Address
First Line	:	1007 AVE MUNOZ RIVERA APT 706
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-2723
Country	:	US
Telephone Number	:	787-425-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 AVE MUNOZ RIVERA STE 1001
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-2724
Country	:	US
Telephone Number	:	787-957-5788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	03/06/2020

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Directions to “ JUANA P CASTILLO MUNOZ PH.D.” Practice Location

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