Provider Demographics
NPI:1447566468
Name:VILLAHERMOSA-CORDOVA, CARLOS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:VILLAHERMOSA-CORDOVA
Suffix:
Gender:M
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:AVE. CONDADO # 605, EDIF. SAN ALBERTO
Mailing Address - Street 2:SUITE 611
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. CONDADO 605
Practice Address - Street 2:EDIFICIO SAN ALBERTO, SUITE 611
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-647-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist