Provider Demographics
NPI:1881675114
Name:DEDOS, PURA DEL CARMEN (PSYD,MA)
Entity type:Individual
Prefix:DR
First Name:PURA
Middle Name:DEL CARMEN
Last Name:DEDOS
Suffix:
Gender:F
Credentials:PSYD,MA
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Mailing Address - Street 1:2431 AVE LAS AMERICAS
Mailing Address - Street 2:EDIFICIO A PORRATA PILA SUITE #205
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2113
Mailing Address - Country:US
Mailing Address - Phone:787-385-3300
Mailing Address - Fax:787-848-5175
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:EDIFICIO A. PORRATA PILA SUITE 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-848-5050
Practice Address - Fax:787-848-5175
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2012-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR1561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical