Provider Demographics
NPI:1003681099
Name:MALLOL, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MALLOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:MALLOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00963
Mailing Address - Country:US
Mailing Address - Phone:787-628-3662
Mailing Address - Fax:
Practice Address - Street 1:PROFESIONAL OFFICES PARK EDIFICIO V (POP-V) PFIZER TOW
Practice Address - Street 2:SUITE 301 996 CALLE SAN ROBERTO SAN JUAN, PR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical