Provider Demographics
NPI:1568193100
Name:CONCEPCION, HECTOR LUIS (PHD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:LUIS
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PASEO LAS CATALINAS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4900
Mailing Address - Country:US
Mailing Address - Phone:787-527-2585
Mailing Address - Fax:
Practice Address - Street 1:AVE. CASA LINDA, SUITE 101
Practice Address - Street 2:CARR. 177, LOS FILTROS KM 2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7333Medicaid