Healthcare Provider Details

I. General information

NPI: 1437013190
Provider Name (Legal Business Name): KIMBERLY PLATA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 AVE HOSTOS
PONCE PR
00717-0952
US

IV. Provider business mailing address

7118 CALLE DIVINA PROVIDENCIA
PONCE PR
00717-1019
US

V. Phone/Fax

Practice location:
  • Phone: 787-499-5404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8836
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: