Healthcare Provider Details

I. General information

NPI: 1699347864
Provider Name (Legal Business Name): ESTEBAN RIOS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CALLE MAYOR
PONCE PR
00730-3726
US

IV. Provider business mailing address

PARC. AMALIA MARIN 4968 CALLE ROBERTO BARACOA COLLADO
PONCE PR
00716-1340
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-3077
  • Fax:
Mailing address:
  • Phone: 787-215-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7051
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: