Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 7081 | PR |
NPI | 1043986375 |
---|---|
Provider Name | Eddie A Soltren-Roldan |
First Address | San Lorenzo, PR 00754-9015 |
Second Address | San Lorenzo, PR 00754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 17/08/2021 |