Provider Demographics
NPI:1851044457
Name:ARROYO ROMAN, CORALIS D
Entity Type:Individual
Prefix:
First Name:CORALIS
Middle Name:D
Last Name:ARROYO ROMAN
Suffix:
Gender:F
Credentials:
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 771
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0771
Mailing Address - Country:US
Mailing Address - Phone:787-963-7070
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KILOMETRO 156.5
Practice Address - Street 2:MEDICAL EMPORIUM L SUITE #203
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-376-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6612102L00000X, 103TA0400X, 103TC0700X, 103TC1900X, 103TF0000X, 103TP2701X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy