MEDICARE: DR. PURA DEL CARMEN DEDOS PSY.D.,M.A.

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	103TC0700X	Clinical Psychologist	1561	PR

General Provider Information

NPI Number	:	1881675114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURA DEL CARMEN DEDOS PSY.D.,M.A.

Provider Business Mailing Address
First Line	:	2431 AVE LAS AMERICAS
Second Line	:	EDIFICIO A PORRATA PILA SUITE #205
City	:	PONCE
State	:	PR
Zip	:	00717-2113
Country	:	US
Telephone Number	:	787-385-3300
Fax Number	:	787-848-5175

Provider Business Practice Location Address
First Line	:	2431 AVE LAS AMERICAS
Second Line	:	EDIFICIO A. PORRATA PILA SUITE 205
City	:	PONCE
State	:	PR
Zip	:	00717-2113
Country	:	US
Telephone Number	:	787-848-5050
Fax Number	:	787-848-5175

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	11/01/2012

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