Provider Demographics
NPI:1326607441
Name:BERRIOS, MAYRA (RCM)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:RCM
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 696
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0696
Mailing Address - Country:US
Mailing Address - Phone:787-349-1454
Mailing Address - Fax:
Practice Address - Street 1:CALLE LIRIO #15 URB. QUINTAS DE CIALES
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-349-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00672225C00000X, 225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100006413OtherID NUMBER