Provider Demographics
NPI:1336595693
Name:BERRIOS, MARIA MAGDALENA
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MAGDALENA
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:
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 80152
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-8152
Mailing Address - Country:US
Mailing Address - Phone:787-751-0475
Mailing Address - Fax:787-751-0475
Practice Address - Street 1:975 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2801
Practice Address - Country:US
Practice Address - Phone:787-751-0475
Practice Address - Fax:787-751-0475
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist