Provider Demographics
NPI:1053913772
Name:DE PUIGDORFILA, FELIPE SEBASTIAN
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:SEBASTIAN
Last Name:DE PUIGDORFILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CALLE YAGUEZ
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9632
Mailing Address - Country:US
Mailing Address - Phone:787-233-6272
Mailing Address - Fax:
Practice Address - Street 1:58 CALLE YAGUEZ
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-9632
Practice Address - Country:US
Practice Address - Phone:787-233-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health