Healthcare Provider Details

I. General information

NPI: 1356560189
Provider Name (Legal Business Name): ADA NYDIA TUA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CALLE RELAMPAGO EDIF. CENTRO DEL OESTE
MAYAGUEZ PR
00680-0000
US

IV. Provider business mailing address

8 CALLE DUARTE
MAYAGUEZ PR
00682-1133
US

V. Phone/Fax

Practice location:
  • Phone: 787-458-2794
  • Fax:
Mailing address:
  • Phone: 787-832-1148
  • Fax: 787-265-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1585
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: