Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 7112 | PR |
NPI | 1003575408 |
---|---|
Provider Name | Aydin Andino Lopez |
First Address | Canovanas, PR 00729-4169 |
Second Address | Canovanas, PR 00729-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |