Provider Demographics
NPI:1578083986
Name:RESTO, AIXA M (COUNSELING)
Entity Type:Individual
Prefix:MRS
First Name:AIXA
Middle Name:M
Last Name:RESTO
Suffix:
Gender:F
Credentials:COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J13 CALLE 11 SANTA ANA
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6005
Mailing Address - Country:US
Mailing Address - Phone:787-397-6870
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN MANUEL #5
Practice Address - Street 2:EDIFICIO YOLANDA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-397-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2082101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor