Provider Demographics
NPI:1669620241
Name:IGLESIAS FULBRIGHT, ELIZABETH J (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:IGLESIAS FULBRIGHT
Suffix:
Gender:F
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:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1391
Mailing Address - Country:US
Mailing Address - Phone:787-454-5232
Mailing Address - Fax:
Practice Address - Street 1:CARR. 844 KM 4.2
Practice Address - Street 2:CUPEY BAJO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-760-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical