Provider Demographics
NPI:1821217043
Name:ESCUDERO, IRIS MARGARITA (PH D)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:MARGARITA
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 CALLE YAGUEZ
Mailing Address - Street 2:RIO PIEDRAS HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3102
Mailing Address - Country:US
Mailing Address - Phone:787-553-5002
Mailing Address - Fax:787-273-8367
Practice Address - Street 1:CARRETERA PR 21
Practice Address - Street 2:BLOQUE U3#11 URB LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-553-5002
Practice Address - Fax:787-273-8367
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR 946103TB0200X, 103TC0700X, 103TC2200X, 103TF0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic