Individual provider Active NPI

Mya Natasha Munoz Burgos, PH.D.

  • Clinical Psychologist
  • Bayamon, PR
National Provider Identifier
1730532409
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5697 Issued in PR
Practice address
F41 Calle Alicia
Royal Gardens
Bayamon, PR 00957-2532
Phone
(787) 516-2005
NPI assigned
Jul 18, 2016
Last updated
Mar 15, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5697 PR Primary

Addresses

Primary practice location

F41 Calle Alicia
Royal Gardens
Bayamon, PR 00957-2532

Mailing address

F41 Calle Alicia
Royal Gardens
Bayamon, PR 00957-2532
Phone (787) 516-2005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170612001446 PR Practitioner - Clinical Psychologist 4284902479 Practice locations: San Juan, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
5697PRMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Servicios Psicologicos Vive, PSC. Clinical PastSince Jun 9, 2012 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1730532409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "F41 CALLE ALICIA",
            "address_2": "ROYAL GARDENS",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009572532",
            "telephone_number": "787-516-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "F41 CALLE ALICIA",
            "address_2": "ROYAL GARDENS",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009572532",
            "telephone_number": "787-516-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNOZ BURGOS",
        "first_name": "MYA",
        "middle_name": "NATASHA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "5697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayamon, PR

Sources for this page

Verify at the official NPI Registry.