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General NPI Number Information
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NPI Number | 1780101279
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Entity Type | Individual
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Provider Name | SIXTO FREDDY PORTILLO COLON PSYD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | AB 18 LOCAL 5 PASEO DE LOS GIGANTES VALLE ARRIBA HEIGHTS
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 939-259-8244
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Fax |
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Provider Business Mailing Address
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Address Line | AB 18 CALLE MORERA VALLE ARRIBA HEIGHTS
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 939-259-8244
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7732
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License Number State | PR
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