Healthcare Provider Details

I. General information

NPI: 1134049174
Provider Name (Legal Business Name): SANDY E NAZARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JUAN R GARZOT #33 LOCAL 3
NAGUABO PR
00718
US

IV. Provider business mailing address

BO EL DUQUE BUZON 1961
NAGUABO PR
00718
US

V. Phone/Fax

Practice location:
  • Phone: 787-325-5083
  • Fax:
Mailing address:
  • Phone: 787-702-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9105
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: