Provider Demographics
NPI:1700294170
Name:AMEZAGA, AMNERIS
Entity Type:Individual
Prefix:
First Name:AMNERIS
Middle Name:
Last Name:AMEZAGA
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:AK-45 CALLE HERMOSILLO
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-458-2914
Mailing Address - Fax:
Practice Address - Street 1:AK45 CALLE HERMOSILLO
Practice Address - Street 2:VENUS GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4695
Practice Address - Country:US
Practice Address - Phone:787-458-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4070103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling