Provider Demographics
NPI:1255974986
Name:SANTANA, YESENIA (PSICOLOGA)
Entity type:Individual
Prefix:MISS
First Name:YESENIA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PSICOLOGA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-2337
Mailing Address - Country:US
Mailing Address - Phone:787-734-1767
Mailing Address - Fax:
Practice Address - Street 1:K 20.1 BARIO PINAS KM 20.1
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-390-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty