Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1265 | PR |
NPI | 1023592573 |
---|---|
Provider Name | Dr. Ariel Chardon |
First Address | Ponce, PR 00728 |
Second Address | Ponce, PR 00728-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |