Provider Demographics
NPI:1770849457
Name:SOLER, LOURDES DE LOS ANGELES (MA)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:DE LOS ANGELES
Last Name:SOLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:DE LOS ANGELES
Other - Last Name:SOLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-0787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HA6 CALLE PALMA SOLA
Practice Address - Street 2:GARDEN HILLS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2921
Practice Address - Country:US
Practice Address - Phone:787-923-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1499103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling