Provider Demographics
NPI:1316423601
Name:AYBAR CRUZ, JOHARYS KAMILA
Entity type:Individual
Prefix:
First Name:JOHARYS
Middle Name:KAMILA
Last Name:AYBAR CRUZ
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:URB. VILLA CAROLINA, CALLE 411 BLOQUE 141 #15
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-627-9285
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:SUITE 307A MULTIPISOS 6TO NIVEL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-627-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist