Healthcare Provider Details

I. General information

NPI: 1417824970
Provider Name (Legal Business Name): JETSY ISUANETTE COLON APONTE SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION STAR LIGHT CALLE GALAXIA 3478 CALLE GALAXIA 3478
PONCE PR
00717
US

IV. Provider business mailing address

URBANIZACION STAR LIGHT CALLE GALAXIA 3478 CALLE GALAXIA 3478
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-324-8978
  • Fax:
Mailing address:
  • Phone: 787-324-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number7679
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: