Healthcare Provider Details

I. General information

NPI: 1093649675
Provider Name (Legal Business Name): ANDREA NICOLE PONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. HOSTOS #410, CARRETERA #2, BO. SABALO
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

10 VILLAS DE LA ESPERANZA
JUANA DIAZ PR
00795-9622
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: