Provider Demographics
NPI:1083028252
Name:CARMONA, ILIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ILIA
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF RIBERAS DEL RIO
Mailing Address - Street 2:APT 207C CALLE 10
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8899
Mailing Address - Country:US
Mailing Address - Phone:787-649-9220
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO RIBERAS DEL RIO
Practice Address - Street 2:APRT 207 C CALLE 10
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-649-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist