Provider Demographics
NPI:1568677201
Name:PABON, WALESKA SOCORRO (PSYD)
Entity type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:SOCORRO
Last Name:PABON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:WALESKA
Other - Middle Name:SOCORRO
Other - Last Name:PABON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:STREET 3 VILLA ROSA
Mailing Address - Street 2:B9
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-6408
Mailing Address - Country:US
Mailing Address - Phone:787-864-1938
Mailing Address - Fax:787-864-1938
Practice Address - Street 1:3 VILLA ROSA
Practice Address - Street 2:B9
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6408
Practice Address - Country:US
Practice Address - Phone:787-864-1938
Practice Address - Fax:787-864-1938
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2020170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR065162OtherCRUZ AZUL
PR21124OtherTRIPLESS