Healthcare Provider Details

I. General information

NPI: 1245444793
Provider Name (Legal Business Name): GLORIA DURAN PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE MUNOZ RIVERA W
RINCON PR
00677-2127
US

IV. Provider business mailing address

110 URB VISTA DEL MAR
MAYAGUEZ PR
00682-6271
US

V. Phone/Fax

Practice location:
  • Phone: 787-823-5500
  • Fax: 787-823-2990
Mailing address:
  • Phone: 787-823-5500
  • Fax: 787-823-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1882
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1882
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: