MEDICARE: JOSHUA ISMAEL COLLADO LUGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	8675	PR
2	103TH0100X	Health Service Psychologist	8675	PR
3	103TC0700X	Clinical Psychologist	8675	PR

General Provider Information

NPI Number	:	1851258487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ISMAEL COLLADO LUGO

Provider Business Mailing Address
First Line	:	URB VALLE DEL REY 4807 CALLE LANCEODA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728
Country	:	US
Telephone Number	:	787-232-3723
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB VALLE DEL REY 4807 CALLE LANCEODA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728
Country	:	US
Telephone Number	:	787-232-3723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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