Provider Demographics
NPI:1639313836
Name:PINA, GLORIVA (PSYCHOLOGIST PSY D)
Entity Type:Individual
Prefix:
First Name:GLORIVA
Middle Name:
Last Name:PINA
Suffix:
Gender:F
Credentials:PSYCHOLOGIST PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ANTONIO MACHADO
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00925
Mailing Address - Country:UM
Mailing Address - Phone:939-405-2005
Mailing Address - Fax:
Practice Address - Street 1:275 ANTONIO MACHADO EL SENORIAL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00925
Practice Address - Country:UM
Practice Address - Phone:939-405-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3145103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1849746OtherPUERTO ROCO DRIVER LICENSE