Provider Demographics
NPI:1639635808
Name:NUNEZ ROSARIO, PEDRO JAVIER (MRC)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JAVIER
Last Name:NUNEZ ROSARIO
Suffix:
Gender:M
Credentials:MRC
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 664
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0664
Mailing Address - Country:US
Mailing Address - Phone:787-484-6549
Mailing Address - Fax:
Practice Address - Street 1:CARR 144 KM 0HM 7
Practice Address - Street 2:BO CARICABOA
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-484-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCAT-IV-52021101YA0400X
PR1625225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)