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General NPI Number Information
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NPI Number | 1366983371
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Entity Type | Individual
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Provider Name | MELANIE LA TORRE LOSTERNAU PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 8 CALLE LIVORNA COND CONCORDIA GDNS 1 APT PH-C
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City | SAN JUAN
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State | PR
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Zip | 00924-0924
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Country | US
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Telephone | 787-923-0314
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 11 CC-32 URB. LAS AMERICAS
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-923-0314
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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 | 005815
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License Number State | PR
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