Provider Demographics
NPI:1285443580
Name:BURGOS CAPESTANY, JORGE EDUARDO
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:EDUARDO
Last Name:BURGOS CAPESTANY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN ANTONIO CALLE DRAMA 2043
Mailing Address - Street 2:
Mailing Address - City:PONCE, PR
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-627-4267
Mailing Address - Fax:
Practice Address - Street 1:CALLE TORRES 77C
Practice Address - Street 2:
Practice Address - City:PONCE, PR
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-627-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist