Provider Demographics
NPI:1801203211
Name:NERIS, WILBERTO
Entity Type:Individual
Prefix:MR
First Name:WILBERTO
Middle Name:
Last Name:NERIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2L4 CALLE R SOTOMAYOR
Mailing Address - Street 2:URB BAIROA PARK
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1123
Mailing Address - Country:US
Mailing Address - Phone:787-447-4417
Mailing Address - Fax:
Practice Address - Street 1:2L4 CALLE R SOTOMAYOR
Practice Address - Street 2:URB BAIROA PARK
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1123
Practice Address - Country:US
Practice Address - Phone:787-447-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4304103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling