Basic Information
| Provider Information | |||||||||
| NPI: | 1407471477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURGOS | ||||||||
| FirstName: | NOEMI | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 3 BOX 17320 | ||||||||
| Address2: | |||||||||
| City: | AGUAS BUENAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007038378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874637457 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CALLE 2 KM 11.8 EDIFICIO CENTURION PISO 3 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2020 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 00547 | PR | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.