Provider Demographics
NPI:1629316948
Name:ALVARADO POMALES, AWILDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AWILDA
Middle Name:
Last Name:ALVARADO POMALES
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 5166
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5166
Mailing Address - Country:US
Mailing Address - Phone:787-586-5082
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE ROBLES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3002
Practice Address - Country:US
Practice Address - Phone:787-586-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004676103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist