Provider Demographics
NPI:1508557265
Name:MUNOZ PLATA, ELEANA
Entity Type:Individual
Prefix:
First Name:ELEANA
Middle Name:
Last Name:MUNOZ PLATA
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:URB HYDE PARK CALLE LOS MIRTOS
Mailing Address - Street 2:APT # 2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-367-8488
Mailing Address - Fax:
Practice Address - Street 1:URB HYDE PARK CALLE LOS MIRTOS # 189
Practice Address - Street 2:APT # 2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-367-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6092103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist