Provider Demographics
NPI:1821864323
Name:NERIS-RODRIGUEZ, MIGUEL LOIZ (PHD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:LOIZ
Last Name:NERIS-RODRIGUEZ
Suffix:
Gender:M
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:PO BOX 7233
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7233
Mailing Address - Country:US
Mailing Address - Phone:787-436-2242
Mailing Address - Fax:
Practice Address - Street 1:URBG. TURABO GARDENS PP10 CALLE 16
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-6073
Practice Address - Country:US
Practice Address - Phone:787-436-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical