1780101279 NPI number — SIXTO FREDDY PORTILLO COLON PSYD

Table of content: SIXTO FREDDY PORTILLO COLON PSYD (NPI 1780101279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780101279 NPI number — SIXTO FREDDY PORTILLO COLON PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTILLO COLON
Provider First Name:
SIXTO
Provider Middle Name:
FREDDY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780101279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AB 18 CALLE MORERA
Provider Second Line Business Mailing Address:
VALLE ARRIBA HEIGHTS
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-259-8244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AB 18 LOCAL 5 PASEO DE LOS GIGANTES
Provider Second Line Business Practice Location Address:
VALLE ARRIBA HEIGHTS
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-259-8244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 7732 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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