=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174544969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RINA ALONSO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE CARAZO #75 APART 913
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-272-8681
-----------------------------------------------------
Fax | 787-790-0550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CONDOMINIO COSTA AZUL APARTAMENTO 3B CALLE TAFT #2
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00911-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-272-8681
-----------------------------------------------------
Fax | 787-790-0550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2098
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------