Provider Demographics
NPI:1205003258
Name:MEDINA COLON, SORALIZ (PSYD)
Entity Type:Individual
Prefix:
First Name:SORALIZ
Middle Name:
Last Name:MEDINA COLON
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:PO BOX 8200
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8200
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:
Practice Address - Street 1:VILLA DEL CARMEN
Practice Address - Street 2:CALLE SALAMANCA 573
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2112
Practice Address - Country:US
Practice Address - Phone:787-843-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical