Healthcare Provider Details

I. General information

NPI: 1053648592
Provider Name (Legal Business Name): ILEANA A. TORRES CORDERO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 CALLE SALVADOR BRAU SUITE 01-B
CABO ROJO PR
00623-3412
US

IV. Provider business mailing address

PO BOX 7444
MAYAGUEZ PR
00681-7444
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-8464
  • Fax: 787-265-8145
Mailing address:
  • Phone: 787-505-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2153
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: