Provider Demographics
NPI:1407940034
Name:CERVERA, RAQUEL
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:CERVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CALLE BETANCES
Mailing Address - Street 2:FLORAL PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-754-1727
Mailing Address - Fax:787-758-4071
Practice Address - Street 1:115 CALLE BETANCES
Practice Address - Street 2:FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-754-1727
Practice Address - Fax:787-758-4071
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRR62298Medicare UPIN
PR0084153Medicare PIN