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General NPI Number Information
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NPI Number | 1134477755
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Entity Type | Individual
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Provider Name | LUDITZA PEREZ BADILLO
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | CARRETERA 115 KM 22 4 BARRIO GUAYABO SECTOR CASUALIDAD
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City | AGUADA
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State | PR
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Zip | 00602-0000
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Country | US
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Telephone | 787-312-1854
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Fax | 787-551-7316
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Provider Business Mailing Address
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Address Line | PO BOX 1308
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City | AGUADA
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State | PR
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Zip | 00602-1308
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Country | US
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Telephone | 787-508-8259
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Fax | 787-868-4720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 4311
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4311
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License Number State | PR
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