Active NPI
Mario Luis Perez Rodriguez, PSYCHOLOGIST
- Psychologist
- Caguas, PR
National Provider Identifier
1164754826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3627
- Practice address
- Med Wellness Clinic
PD Plaza Local 3
Caguas, PR 00725 - Phone
- (787) 453-6132
- NPI assigned
- Feb 5, 2010
- Last updated
- Oct 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3627 | PR | Primary |
Addresses
Primary practice location
Med Wellness Clinic
PD Plaza Local 3
Caguas, PR 00725
Mailing address
Urb.Veredas
#389
Gurabo, PR 00778
Phone (787) 453-6132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3627 | Other | PR | LISENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impower, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Longwood, FL
- NPI 1104910868
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1164754826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "URB.VEREDAS",
"address_2": "#389",
"city": "GURABO",
"state": "PR",
"postal_code": "00778",
"telephone_number": "787-453-6132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MED WELLNESS CLINIC",
"address_2": "PD PLAZA LOCAL 3",
"city": "CAGUAS",
"state": "PR",
"postal_code": "00725",
"telephone_number": "787-453-6132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ RODRIGUEZ",
"first_name": "MARIO",
"middle_name": "LUIS",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-05",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PR",
"license": "3627",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LISENCE",
"identifier": "3627",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caguas, PR
- Ismael Gabriel Perez Martinez
- Jose Julio Perez Matamoros, M.D.
- Ismael Perez Naveira, MD
- Perez Palmer de Jesus (Centro de Medicina Integrada)
- Yarelis Marie Perez Rivera, M.D.
- Frances Perez Santana, PSY.D.
- Elizabeth Perez Santiago, DMD
- Gabriela Paola Perez Toledo, PHARMD
- Jose Manuel Perez Yordan, M.D.
- Sergio Perez-Acosta, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.