Provider Demographics
NPI:1093873770
Name:MOJICA, MARIA TERESA (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TERESA
Last Name:MOJICA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 AVE ISLA VERDE
Mailing Address - Street 2:PMB 1213
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-281-0032
Mailing Address - Fax:787-767-3412
Practice Address - Street 1:CALLE MAYAGUEZ #45 ESQ CALLE COAMO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-281-0032
Practice Address - Fax:787-767-3412
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6729OtherIMC
PR2985OtherAPS