Healthcare Provider Details

I. General information

NPI: 1932453669
Provider Name (Legal Business Name): CARLOS ALBIZU UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE TANCA 151 ESQUINA SAN FRANCISCO VIEJO SAN JUAN
SAN JUAN PR
00902
US

IV. Provider business mailing address

PO BOX 9023711
SAN JUAN PR
00902-3711
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax: 787-721-7183
Mailing address:
  • Phone: 787-725-6500
  • Fax: 787-721-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1206
License Number StatePR

VIII. Authorized Official

Name: DR. NANET MARIE LOPEZ-CORDOVA
Title or Position: PSYD PROGRAM DIRECTOR
Credential: PSY.D.
Phone: 787-725-6500