Provider Demographics
NPI:1023672482
Name:BERRIOS, LOURDES JEANNETTE I (RTP)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:JEANNETTE
Last Name:BERRIOS
Suffix:I
Gender:M
Credentials:RTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0204
Mailing Address - Country:US
Mailing Address - Phone:787-516-2692
Mailing Address - Fax:
Practice Address - Street 1:CARR 159
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2903
Practice Address - Country:US
Practice Address - Phone:787-345-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist