Provider Demographics
NPI:1629553185
Name:BERRIOS GOMEZ, KARIM (TECH 12072)
Entity Type:Individual
Prefix:MISS
First Name:KARIM
Middle Name:
Last Name:BERRIOS GOMEZ
Suffix:
Gender:F
Credentials:TECH 12072
Other - Prefix:MISS
Other - First Name:KARIM
Other - Middle Name:
Other - Last Name:BERRIOS GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:URB SANTA CLARA #150 CARR 9931 STE1
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-687-7997
Mailing Address - Fax:787-687-7994
Practice Address - Street 1:SUITE 06 RALPH PLAZA
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-687-7997
Practice Address - Fax:787-687-7994
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012072156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist