MEDICARE: JOSE MIGUEL FREYRE MS

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	103T00000X	Psychologist	3104	PR

General Provider Information

NPI Number	:	1720244007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE MIGUEL FREYRE MS

Provider Business Mailing Address
First Line	:	100 AVE LAS SIERRAS
Second Line	:	APT K-163
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5905
Country	:	US
Telephone Number	:	787-975-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AVE LAS SIERRAS
Second Line	:	APT K-163
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5905
Country	:	US
Telephone Number	:	787-731-5785
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	09/04/2008

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