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General NPI Number Information
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NPI Number | 1285914036
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Entity Type | Individual
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Provider Name | LORNA L BOU AQUINO M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 819 HOSTOS AVE.
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-841-8686
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Fax | 787-843-1288
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Provider Business Mailing Address
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Address Line | 3 SKYTOWER APT. 12-I
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-547-1187
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2385
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License Number State | PR
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