Provider Demographics
NPI:1487870903
Name:PEREZ-BURGOS, MARIBEL (PSYD)
Entity type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:PEREZ-BURGOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CALLE GUARIONEX
Mailing Address - Street 2:COLINAS DE BAYOAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-3783
Mailing Address - Country:US
Mailing Address - Phone:787-799-2175
Mailing Address - Fax:
Practice Address - Street 1:100 AVE LAUREL , CENTRO PEDIATRICO DE BAYAMON
Practice Address - Street 2:HOSPITAL REGIONAL DE BAYAMON, SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-778-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1371103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent