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General NPI Number Information
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NPI Number | 1124576020
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Entity Type | Organization
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Legal Business Name | CLINICA KALLIS COLON PSC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 1600 AVE PONCE DE LEON 1 ST FLOOR
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City | SAN JUAN
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State | PR
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Zip | 00909-1844
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Country | US
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Telephone | 787-724-9797
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Fax | 787-724-9700
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Provider Business Mailing Address
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Address Line | 1600 AVE PONCE DE LEON 1 ST FLOOR
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City | SAN JUAN
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State | PR
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Zip | 00909-1844
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Country | US
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Telephone | 787-724-9797
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Fax | 787-724-9700
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGISY
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Name | ISABELLE KALLIS COLON
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Credential | PH.D
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Telephone | 787-617-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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