=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669415121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADALISSE BORGES HERNANDEZ PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 01/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1710 AVE PALACIOS DE VERSALLES PALACIOS DE VERSALLES
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-607-5666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1710 AVE PALACIOS DE VERSALLES PALACIOS DE VERSALLES
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-607-5666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 2630
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------