Provider Demographics
NPI:1346518404
Name:OFICINA DR. ROBERTO REGO
Entity Type:Organization
Organization Name:OFICINA DR. ROBERTO REGO
Other - Org Name:OFICINA DR. ROBERTO REGO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REGO
Authorized Official - Middle Name:RV
Authorized Official - Last Name:ROBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-226-5931
Mailing Address - Street 1:COND. ALTOS DE LA COLINA 1600 RAMAL 842
Mailing Address - Street 2:APT. 108
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-299-5735
Mailing Address - Fax:
Practice Address - Street 1:1600 RAMAL 842
Practice Address - Street 2:APT 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9648
Practice Address - Country:US
Practice Address - Phone:787-226-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2080103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty