Provider Demographics
NPI:1174764815
Name:SANTALIZ, RAQUEL MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:MARIA
Last Name:SANTALIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 WESTERN AUTO PLAZA SUITE 101
Mailing Address - Street 2:PMB 122
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-370-9289
Mailing Address - Fax:
Practice Address - Street 1:AA-14 MARGINAL CARR. #3
Practice Address - Street 2:ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-934-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical