Provider Demographics
NPI:1952541609
Name:PEREZ-BURGOS, ROSALICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSALICE
Middle Name:
Last Name:PEREZ-BURGOS
Suffix:
Gender:F
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:POBOX 29777
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00929
Mailing Address - Country:UM
Mailing Address - Phone:787-752-4464
Mailing Address - Fax:787-257-4195
Practice Address - Street 1:YABOA REAL STREET # 830
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-752-4464
Practice Address - Fax:787-257-4195
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical