Healthcare Provider Details

I. General information

NPI: 1639910367
Provider Name (Legal Business Name): ALEJANDRA RIVERA-SANTIAGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEJANDRA RIVERA-SANTIAGO PSYD

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO VISTA REAL I APT. D122
CAGUAS PR
00727
US

IV. Provider business mailing address

CONDOMINIO VISTA REAL I APT. D122
CAGUAS PR
00727
US

V. Phone/Fax

Practice location:
  • Phone: 787-344-8261
  • Fax:
Mailing address:
  • Phone: 787-344-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6888
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number6888
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: