Basic Information
| Provider Information | |||||||||
| NPI: | 1588891345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRION LUNA | ||||||||
| FirstName: | MELISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CARRION LUNA | ||||||||
| OtherFirstName: | MELISA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MRS. | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | HC 02 BOX 13211 | ||||||||
| Address2: | |||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00778 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | AVE. GAUTIER BENITEZ LOCAL B5 CONSOLIDATED MALL | ||||||||
| Address2: | INSTITUTO PSICOTERAPEUTICO DE PR | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 06/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 2534 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.