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General NPI Number Information
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NPI Number | 1346125622
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Entity Type | Individual
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Provider Name | GEDALIS PABON SAN INOCENCIO
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Gender |
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | BO. MACHUELO, EDIFICIO SAN LUCAS #2 CARR. 14
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City | PONCE
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State | PR
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Zip | 00931
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Country | US
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Telephone | 787-429-5059
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Fax |
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Provider Business Mailing Address
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Address Line | URB COUNTRY CLUB OB10 CALLE 502 4TA EXT
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-429-5059
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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 |
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License Number State |
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