Provider Demographics
NPI:1417686320
Name:DUPONT, MARIBEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:PHD
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 2093
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2093
Mailing Address - Country:US
Mailing Address - Phone:787-826-4444
Mailing Address - Fax:
Practice Address - Street 1:CARR # 2 KM 142.2
Practice Address - Street 2:BO. QUEBRADA LARGA
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0000
Practice Address - Country:US
Practice Address - Phone:787-509-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist