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General NPI Number Information
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NPI Number | 1205003258
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Entity Type | Individual
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Provider Name | SORALIZ MEDINA COLON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | VILLA DEL CARMEN CALLE SALAMANCA 573
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City | PONCE
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State | PR
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Zip | 00716-2112
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Country | US
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Telephone | 787-843-4989
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8200
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City | PONCE
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State | PR
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Zip | 00732-8200
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Country | US
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Telephone | 787-843-9393
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3006
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License Number State | PR
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