Provider Demographics
NPI:1205142569
Name:PIMENTEL, LUZ MARIANNE (MA)
Entity type:Individual
Prefix:MS
First Name:LUZ
Middle Name:MARIANNE
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S65 AVE EL CONQUISTADOR
Mailing Address - Street 2:VALLE VERDE VEVE CALZADA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3723
Mailing Address - Country:US
Mailing Address - Phone:787-379-2978
Mailing Address - Fax:
Practice Address - Street 1:RD 3 KM 27.0
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-513-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist