Provider Demographics
NPI:1285815134
Name:NOGALES MARIN, JORGE E (MA)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:E
Last Name:NOGALES MARIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CALLE DEL PARQUE
Mailing Address - Street 2:5TH. FLOOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3709
Mailing Address - Country:US
Mailing Address - Phone:787-721-4960
Mailing Address - Fax:787-721-4961
Practice Address - Street 1:403 CALLE DEL PARQUE
Practice Address - Street 2:5TH. FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3709
Practice Address - Country:US
Practice Address - Phone:787-721-4960
Practice Address - Fax:787-721-4961
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical