Provider Demographics
NPI:1194813345
Name:PEREZ-MOJICA, DEBORAH (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PEREZ-MOJICA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11396
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1396
Mailing Address - Country:US
Mailing Address - Phone:787-758-3029
Mailing Address - Fax:787-792-9991
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3523
Practice Address - Country:US
Practice Address - Phone:787-758-3029
Practice Address - Fax:787-792-9991
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1409103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR76397Medicare ID - Type Unspecified