Provider Demographics
NPI:1679087795
Name:CASTILLO MUNOZ, JUANA P (PHD)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:P
Last Name:CASTILLO MUNOZ
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 1:1007 AVE MUNOZ RIVERA APT 706
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2723
Mailing Address - Country:US
Mailing Address - Phone:787-425-9885
Mailing Address - Fax:
Practice Address - Street 1:1007 AVE MUNOZ RIVERA STE 1001
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2724
Practice Address - Country:US
Practice Address - Phone:787-957-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005405OtherPUERTO RICO PHSICOLOGIST LICENCE
PR160126OtherREGISTRY NUMBER