Healthcare Provider Details

I. General information

NPI: 1851258487
Provider Name (Legal Business Name): JOSHUA ISMAEL COLLADO LUGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VALLE DEL REY 4807 CALLE LANCEODA
PONCE PR
00728
US

IV. Provider business mailing address

URB VALLE DEL REY 4807 CALLE LANCEODA
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 787-232-3723
  • Fax:
Mailing address:
  • Phone: 787-232-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8675
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number8675
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8675
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: