Healthcare Provider Details

I. General information

NPI: 1013830488
Provider Name (Legal Business Name): IVELISSE TORRES FERNANDEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 64 ESQUINA CALLE # 3 URB. INDUSTRIAL
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

744 CALLE MOLINOS
HORMIGUEROS PR
00660-9608
US

V. Phone/Fax

Practice location:
  • Phone: 787-838-7272
  • Fax:
Mailing address:
  • Phone: 787-838-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2704
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: