Provider Demographics
NPI:1093984429
Name:BERRIOS, MARIA V (MT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:V
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:MT
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 10050
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0050
Mailing Address - Country:US
Mailing Address - Phone:787-876-8536
Mailing Address - Fax:787-876-8536
Practice Address - Street 1:CALLE 1 D-7
Practice Address - Street 2:VILLAS DE LOIZA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-8536
Practice Address - Fax:787-876-8536
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR700291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038304Medicare PIN