Healthcare Provider Details

I. General information

NPI: 1205366341
Provider Name (Legal Business Name): NILDA R COLON TORRES PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CALLE BARCELO # 53
BARRANQUITAS PR
00794-1621
US

IV. Provider business mailing address

PO BOX 225
BARRANQUITAS PR
00794-0225
US

V. Phone/Fax

Practice location:
  • Phone: 787-857-2688
  • Fax: 787-857-1730
Mailing address:
  • Phone: 787-202-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3207
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: