Provider Demographics
NPI:1528835329
Name:BERRIOS CASTILLO, MAIRIM NAOMI
Entity type:Individual
Prefix:
First Name:MAIRIM
Middle Name:NAOMI
Last Name:BERRIOS CASTILLO
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 1:404 CALLE GAUTIER BENITEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3612
Mailing Address - Country:US
Mailing Address - Phone:787-674-3537
Mailing Address - Fax:
Practice Address - Street 1:404 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3612
Practice Address - Country:US
Practice Address - Phone:787-674-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program