Provider Demographics
NPI:1184428773
Name:ALONSO, ADA (PHD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 8760
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9759
Mailing Address - Country:US
Mailing Address - Phone:787-503-8889
Mailing Address - Fax:
Practice Address - Street 1:1808 AVE DEL VALLE
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3901
Practice Address - Country:US
Practice Address - Phone:787-503-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist