Healthcare Provider Details

I. General information

NPI: 1720978331
Provider Name (Legal Business Name): MICHELLE MARIE PINO AMOROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON NUM #49 BO. ASOMANTE
AGUADA PR
00602
US

IV. Provider business mailing address

35 CARR 467
AGUADILLA PR
00603-6677
US

V. Phone/Fax

Practice location:
  • Phone: 787-458-4149
  • Fax:
Mailing address:
  • Phone: 787-201-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8504
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: