Provider Demographics
NPI:1942352513
Name:PIAZZA, JAVIER A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:A
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 645 BOX 6387
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-9746
Mailing Address - Country:US
Mailing Address - Phone:787-292-0205
Mailing Address - Fax:
Practice Address - Street 1:200 AVE CUPEY GDNS
Practice Address - Street 2:PLAZA CUPEY GARDENS, SECTOR #3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7341
Practice Address - Country:US
Practice Address - Phone:787-292-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR55451Medicare ID - Type Unspecified