Provider Demographics
NPI:1346350022
Name:JACKSON MOYA, IRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:JACKSON MOYA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:MARGOT
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:864 ASHFORD AVE
Mailing Address - Street 2:FLAMBOYAN APTS 506
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-766-0940
Mailing Address - Fax:
Practice Address - Street 1:864 ASHFORD AVE
Practice Address - Street 2:FLAMBOYAN APTS 506
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-766-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker