Provider Demographics
NPI:1366983371
Name:LA TORRE LOSTERNAU, MELANIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:LA TORRE LOSTERNAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 11 CC-32
Mailing Address - Street 2:URB. LAS AMERICAS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-923-0314
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE LIVORNA
Practice Address - Street 2:COND CONCORDIA GDNS 1 APT PH-C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-0924
Practice Address - Country:US
Practice Address - Phone:787-923-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005815103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist