Provider Demographics
NPI:1174544969
Name:ALONSO, RINA
Entity type:Individual
Prefix:
First Name:RINA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO COSTA AZUL APARTAMENTO 3B CALLE TAFT #2
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1235
Mailing Address - Country:US
Mailing Address - Phone:787-272-8681
Mailing Address - Fax:787-790-0550
Practice Address - Street 1:CALLE CARAZO #75 APART 913
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-272-8681
Practice Address - Fax:787-790-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21588Medicare ID - Type Unspecified