Healthcare Provider Details

I. General information

NPI: 1821947151
Provider Name (Legal Business Name): JEANNIELYS FERNANDEZ QUILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VILLA GRILLASCA BLOQUE A #15-B AVENIDA LAS AMERICAS
PONCE PR
00717
US

IV. Provider business mailing address

URB. LOS CAOBOS CALLE MOTILLO #2099
PONCE PR
00716-2701
US

V. Phone/Fax

Practice location:
  • Phone: 787-539-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8716
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: