Healthcare Provider Details

I. General information

NPI: 1104739630
Provider Name (Legal Business Name): CENTRO AVANZA SERVICIOS PSICOLOGICOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 125 KM 10.1
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 2318
MOCA PR
00676-2318
US

V. Phone/Fax

Practice location:
  • Phone: 787-966-0345
  • Fax:
Mailing address:
  • Phone: 787-966-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ABIGIAL CORDERO ROBLES
Title or Position: MANAGING MEMBER
Credential:
Phone: 787-996-0345