Healthcare Provider Details

I. General information

NPI: 1922345826
Provider Name (Legal Business Name): CARLOS F SELLAS HERNANDEZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 09/13/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. INDUSTRIAL REPARADA 2 396 DR. LUIS F. SALA
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-2525
  • Fax:
Mailing address:
  • Phone: 787-464-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4714
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: